title: The clinical management of patients on partial/total extracorporeal support.
abstract: OBJECTIVE
  Despite advances in extracorporeal membrane oxygenation (ECMO) technology, much is unknown about the optimal management strategies for patients receiving extracorporeal support. There is a growing body of literature investigating patient selection and outcomes, mechanical ventilation approaches, anticoagulation, pharmacokinetics, early mobilization, and the role of ECMO transport among others.
  
  
  RESULTS
  Nonrandomized data suggest a survival advantage from ECMO compared with conventional management in acute respiratory distress syndrome, with mechanical ventilation practices varying widely across centers. A randomized controlled trial is currently ongoing with standardized ventilation approaches in both arms. Low-level anticoagulation appears to be well tolerated, and ECMO circuitry appears to affect the pharmacokinetics of certain drugs. Pilot and matched cohort studies suggest that extracorporeal carbon dioxide removal is effective in preventing intubation in chronic obstructive pulmonary disease, with larger randomized studies being planned. ECMO may be successful in bridging selected patients to lung transplantation, with early mobilization serving as a well tolerated and effective means of optimizing these patients. Regionalization of ECMO may maximize outcomes and is facilitated by the development of ECMO transport teams.
  
  
  CONCLUSIONS
  Recently published data highlight the evolving management strategies of patients receiving extracorporeal support and help identify those patients most appropriate for ECMO and extracorporeal carbon dioxide removal. More data will ultimately be needed to develop an evidence-based consensus.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, New York City, New York, USA.
authors.forename: Darryl
authors.initials: D
authors.lastname: Abrams
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D002245:Carbon Dioxide / Q000097:blood*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D018450:Disease Progression; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D002245:Carbon Dioxide