title: Trends in and perspectives on extracorporeal membrane oxygenation for severe adult respiratory failure.
abstract: Various approaches such as ventilator management involving lung-protective ventilation, corticosteroids, prone positioning, and nitric oxide have failed to maintain sufficient lung oxygenation or appropriate ventilation competence in very severe acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) has been aggressively introduced for such patients, although in only a few institutions. The clinical usefulness of ECMO in a large-scale multicenter study (CESAR trial, 2009) and continued development/improvement of ECMO devices have facilitated performance of ECMO, with further increase in the number of institutions adopting ECMO therapy. Clinical usefulness of ECMO was documented in many cases of severe ARDS secondary to influenza A (H1N1) 2009 infection. ECMO requires establishment of an appropriate management system to minimize fatal complications (e.g., hemorrhage), which requires a multidisciplinary team. This, in combination with a new technique, interventional lung assist, will further extend the indications for ECMO. ECMO can be expected to gain importance as a respiratory support technique.
authors.affiliation: Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba, 260-8677, Japan. sadahiro-t@faculty.chiba-u.jp
authors.forename: Tomohito
authors.initials: T
authors.lastname: Sadahiro
authors.forename: Shigeto
authors.initials: S
authors.lastname: Oda
authors.forename: Masataka
authors.initials: M
authors.lastname: Nakamura
authors.forename: Yo
authors.initials: Y
authors.lastname: Hirayama
authors.forename: Eizo
authors.initials: E
authors.lastname: Watanabe
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Tateishi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Shinozaki
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000266:history / Q000379:methods / Q000639:trends; D049673:History, 20th Century; D006801:Humans; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000628:therapy*