Extracorporeal life support in the management of severe respiratory failure

Abstract

ECLS is a safe and effective means to keep patients alive during severe respiratory failure that would otherwise be fatal. In addition to direct and indirect treatment of the lungs during ECLS, the technique allows days of time for study and treatment of other conditions and other organ failure. The technique has been refined in newborn infants and children, in whom survival rates are high and the technology is proven by prospective randomized trials. ECLS is usually applied to adults with respiratory failure when the mortality risk is over 80%. With these indications, the survival rate in experienced centers is 50% to 60%. A new prospective, randomized trial of ECLS in adult patients is underway in the United Kingdom. In the meantime, intensivists who are charged with the management of moribund ARDS patients who fail to respond to other methods of therapy should consider the risks versus the benefits of transferring such patients to an ECLS center.