title: Venovenous extracorporeal membrane oxygenation for acute lung failure in adults.
abstract: BACKGROUND
  Acute lung failure (ALF) is an increasing problem that can be treated with venovenous extracorporeal membrane oxygenation (vv-ECMO). This report summarizes prospectively collected data of an institutional experience with vv-ECMO.
  
  
  METHODS
  From January 2007 to December 2010, 176 patients (mean age, 48 ± 16; range, 14-78 years) with ALF refractory to conventional therapy were supported with vv-ECMO. The general indication for vv-ECMO was a partial oxygen pressure/fraction of inspired oxygen (Fio(2)) < 80 mm Hg under a Fio(2) of 1.0, a positive end-expiratory pressure of 18 cm H(2)O, and refractory respiratory acidosis (pH < 7.25), despite optimization of conservative therapy.
  
  
  RESULTS
  All patients underwent peripheral cannulation. In 59 cases, vv-ECMO was placed in another facility with ECMO transport by helicopter or ambulance. The mean vv-ECMO support interval was 12 ± 9.0 days (range, 1-67 days). During ECMO, 12 patients (7%) could be extubated and stepwise mobilized. Cannula-related complications during long-term support occurred in 14%, which was mostly minor bleeding. Overall survival was 56%: 58 patients (33%) died during mechanical support, and 20 (11%) died after weaning from the system. The best outcome was noted in trauma patients. Risk factors were mainly advanced age and multiorgan failure.
  
  
  CONCLUSIONS
  Modern vv-ECMO is an excellent treatment in patients with severe ALF and should be more liberally used.
authors: Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany. christof.schmid@klinik.uni-regensburg.de
authors: Christof
authors: C
authors: Schmid
authors: Alois
authors: A
authors: Philipp
authors: Michael
authors: M
authors: Hilker
authors: Leopold
authors: L
authors: Rupprecht
authors: Matthias
authors: M
authors: Arlt
authors: Andreas
authors: A
authors: Keyser
authors: Matthias
authors: M
authors: Lubnow
authors: Thomas
authors: T
authors: Müller
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014680:Veins; D055815:Young Adult