title: Venovenous extracorporeal membrane oxygenation for acute respiratory failure : A clinical review from an international group of experts.
abstract: Despite expensive life-sustaining interventions delivered in the ICU, mortality and morbidity in patients with acute respiratory failure (ARF) remain unacceptably high. Extracorporeal membrane oxygenation (ECMO) has emerged as a promising intervention that may provide more efficacious supportive care to these patients. Improvements in technology have made ECMO safer and easier to use, allowing for the potential of more widespread application in patients with ARF. A greater appreciation of the complications associated with the placement of an artificial airway and mechanical ventilation has led clinicians and researchers to seek viable alternatives to providing supportive care in these patients. Thus, this review will summarize the current knowledge regarding the use of venovenous (VV)-ECMO for ARF and describe some of the recent controversies in the field, such as mechanical ventilation, anticoagulation and transfusion therapy, and ethical concerns in patients supported with VV-ECMO.
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. eddy.fan@uhn.ca.|Extracorporeal Life Support Program, Toronto General Hospital, 585 University Avenue, PMB 11-123, Toronto, ON, M5G 2N2, Canada. eddy.fan@uhn.ca.
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.affiliation: Dip Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda, Ospendale Maggiore Policlinico, Dip Fisiopatologia Medico Chirurgica e dei trapianti, Universita degli Studi di Milano, Milan, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
authors.affiliation: Medical Intensive Care Unit, Groupe Hospitalier Pitie-Salpetriere, Institute of Cardiometabolism and Nutrition, Pierre Marie Curie University, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.affiliation: Medical Intensive Care Unit, Groupe Hospitalier Pitie-Salpetriere, Institute of Cardiometabolism and Nutrition, Pierre Marie Curie University, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Division of Pediatric Cardiothoracic Surgery and Pediatric Heart Centre, Montefiore Health System, Albert Einstein University, New York, NY, USA.
authors.forename: Giles
authors.initials: G
authors.lastname: Peek
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Brodie
authors.affiliation: Department of Internal Medicine II, University Medical Center of Regensburg, University of Regensburg, Regensburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Muller
authors.affiliation: Department of Anesthesiology and Intensive Care, Policlinico Umberto 1, Sapienza University of Rome, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Morelli
authors.affiliation: Department of Anesthesiology and Intensive Care, Policlinico Umberto 1, Sapienza University of Rome, Rome, Italy.
authors.forename: V Marco
authors.initials: VM
authors.lastname: Ranieri
authors.affiliation: Dip Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda, Ospendale Maggiore Policlinico, Dip Fisiopatologia Medico Chirurgica e dei trapianti, Universita degli Studi di Milano, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.|Keenan Research Centre, Li Ka-Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.affiliation: Department of Epidemiology and Preventive Medicine, ANZIC-RC, Monash University and Physiotherapy Department, The Alfred, Melbourne, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Hodgson
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, CHU Nord, Aix-Marseille Université, Marseille, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Van Kiersbilck
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, CHU Nord, UMR CNRS 7278, Aix-Marseille Université, Marseille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.affiliation: Anaesthesiologie II-Operative Intensivmedizin, Universitatsklinikum Gottingen, Gottingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Quintel
authors.affiliation: Réanimation des Détresses Respiratoires et Infections Sévères, CHU Nord, UMR CNRS 7278, Aix-Marseille Université, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001803:Blood Transfusion; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*
chemical_list: D000925:Anticoagulants
keywords: Critical care; Extracorporeal membrane oxygenation; Intensive care units; Respiratory distress syndrome, adult; Respiratory failure; Review; Ventilation, artificial