title: Role of extracorporeal membrane oxygenation in adult respiratory failure: an overview.
abstract: Extracorporeal membrane oxygenation (ECMO) provides complete or partial support of the heart and lungs. Ever since its inception in the 1960s, it has been used across all age groups in the management of refractory respiratory failure and cardiogenic shock. While it has gained widespread acceptance in the neonatal and pediatric physician community, ECMO remains a controversial therapy for Acute Respiratory Distress Syndrome (ARDS) in adults. Its popularity was revived during the swine flu (H1N1) pandemic and advancements in technology have contributed to its increasing usage. ARDS continues to be a potentially devastating condition with significant mortality rates. Despite gaining more insights into this entity over the years, mechanical ventilation remains the only life-saving, yet potentially harmful intervention available for ARDS. ECMO shows promise in this regard by offering less dependence on mechanical ventilation, thereby potentially reducing ventilator-induced injury. However, the lack of rigorous clinical data has prevented ECMO from becoming the standard of care in the management of ARDS. Therefore, the results of two large ongoing randomized trials, which will hopefully throw more light on the role of ECMO in the management of this disease entity, are keenly awaited. In this article we will provide a basic overview of the development of ECMO, the types of ECMO, the pathogenesis of ARDS, different ventilation strategies for ARDS, the role of ECMO in ARDS and the role of ECMO as a bridge to lung transplantation.
authors: a Division of Pulmonary, Critical Care and Sleep Medicine , New York Medical College , Valhalla , NY , USA.
authors: Suneesh
authors: S
authors: Anand
authors: b Department of Medicine , New York Medical College , Valhalla , NY , USA.
authors: Divya
authors: D
authors: Jayakumar
authors: b Department of Medicine , New York Medical College , Valhalla , NY , USA.|c Division of Cardiology , New York Medical College , Valhalla , NY , USA.
authors: Wilbert S
authors: WS
authors: Aronow
authors: a Division of Pulmonary, Critical Care and Sleep Medicine , New York Medical College , Valhalla , NY , USA.
authors: Dipak
authors: D
authors: Chandy
mesh_terms: D000328:Adult; D002648:Child; D000075202:Contraindications; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D010100:Oxygen / Q000627:therapeutic use*; D010107:Oxygenators, Membrane / Q000706:statistics & numerical data*; D011659:Pulmonary Gas Exchange; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D016879:Salvage Therapy; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: Acute Respiratory Distress Syndrome; Extracorporeal membrane oxygenation; extracorporeal carbon dioxide removal; lung protective ventilation; lung transplantation