[Extracorporeal gas exchange procedures. Differentiated therapy when conventional ventilation reaches the limits].
In recent years the range of products for extracorporeal lung support has substantially expanded. In principle systems generating high blood flow and thus enabling oxygenation and decarboxylation, corresponding to classical extracorporeal membrane oxygenation (ECMO), can be distinguished from low-flow systems, enabling decarboxylation only. Technical progress and new data have led to a novel insight into the role of ECMO as an invasive, ultimate therapy in refractory life-threatening lung failure towards a broader range of applications even in spontaneously breathing and awake patients. Indications for extracorporeal decarboxylation, initially thought to enable most protective ventilator settings, have been extended to forms of hypercapnic lung failure and towards avoidance of intubation and mechanical ventilation itself in patients with isolated hypercapnia and failure of non-invasive ventilation. It has to be emphasized however, that due to a still sparse amount of literature and potentially deleterious complications associated with extracorporeal lung support, these kinds of therapies should be reserved for specialized and experienced centers.
Allgemeines Krankenhaus der Stadt Wien, Universitätsklinik für Innere Medizin I, Intensivstation 13.i2, Medizinische Universität Wien, Währinger Gürtel 18-20, Vienna, Austria. thomas.staudinger@meduniwien.ac.at
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D022561:Advanced Cardiac Life Support / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D001317:Austria; D002245:Carbon Dioxide / Q000097:blood; D003422:Critical Care / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D006935:Hypercapnia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008168:Lung / Q000503:physiopathology; D010100:Oxygen / Q000097:blood; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D062606:Tertiary Care Centers
D002245:Carbon Dioxide; D010100:Oxygen