Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies

doi:10.1186/1471-2253-14-65

Review

. 2014 Aug 6:14:65.

doi: 10.1186/1471-2253-14-65. eCollection 2014.

Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies

David B Tulman¹, Stanislaw P A Stawicki², Bryan A Whitson³, Saarik C Gupta⁴, Ravi S Tripathi¹, Michael S Firstenberg⁵, Don Hayes Jr⁶, Xuzhong Xu⁷, Thomas J Papadimos¹

Affiliations

¹ Department of Anesthesiology, Wexner Medical Center at The Ohio State, University, 410 W 10th Ave, Columbus 43210, OH, USA.
² Department of Surgery, Division of Critical Care, Trauma, and Burn, Wexner Medical Center at The Ohio State University, 410 W 10th Ave, Columbus 43210, OH, USA.
³ Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center at The Ohio State University, 410 W 10th Ave, Columbus 43210, OH, USA.
⁴ Department of Anesthesiology, Wexner Medical Center at The Ohio State, University, 410 W 10th Ave, Columbus 43210, OH, USA ; Northeast Ohio Medical University, 4209 SR 44, PO Box 95, Rootstown 44272, OH, USA.
⁵ Cardiothoracic Surgery, Summa Akron City Hospital, 75 Arch St, Akron 44304, OH, USA.
⁶ Pulmonary Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus 43205, OH, USA.
⁷ Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical College, 2 Fuxue Road, 32500 Zhejiang, China.

PMID: 25110462
PMCID: PMC4126084
DOI: 10.1186/1471-2253-14-65

Review

Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies

David B Tulman et al. BMC Anesthesiol. 2014.

. 2014 Aug 6:14:65.

doi: 10.1186/1471-2253-14-65. eCollection 2014.

Authors

David B Tulman¹, Stanislaw P A Stawicki², Bryan A Whitson³, Saarik C Gupta⁴, Ravi S Tripathi¹, Michael S Firstenberg⁵, Don Hayes Jr⁶, Xuzhong Xu⁷, Thomas J Papadimos¹

Affiliations

¹ Department of Anesthesiology, Wexner Medical Center at The Ohio State, University, 410 W 10th Ave, Columbus 43210, OH, USA.
² Department of Surgery, Division of Critical Care, Trauma, and Burn, Wexner Medical Center at The Ohio State University, 410 W 10th Ave, Columbus 43210, OH, USA.
³ Department of Surgery, Division of Cardiac Surgery, Wexner Medical Center at The Ohio State University, 410 W 10th Ave, Columbus 43210, OH, USA.
⁴ Department of Anesthesiology, Wexner Medical Center at The Ohio State, University, 410 W 10th Ave, Columbus 43210, OH, USA ; Northeast Ohio Medical University, 4209 SR 44, PO Box 95, Rootstown 44272, OH, USA.
⁵ Cardiothoracic Surgery, Summa Akron City Hospital, 75 Arch St, Akron 44304, OH, USA.
⁶ Pulmonary Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus 43205, OH, USA.
⁷ Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical College, 2 Fuxue Road, 32500 Zhejiang, China.

PMID: 25110462
PMCID: PMC4126084
DOI: 10.1186/1471-2253-14-65

Abstract

Background: Following the 2009 H1N1 Influenza pandemic, extracorporeal membrane oxygenation (ECMO) emerged as a viable alternative in selected, severe cases of ARDS. Acute Respiratory Distress Syndrome (ARDS) is a major public health problem. Average medical costs for ARDS survivors on an annual basis are multiple times those dedicated to a healthy individual. Advances in medical and ventilatory management of severe lung injury and ARDS have improved outcomes in some patients, but these advances fail to consistently "rescue" a significant proportion of those affected.

Discussion: Here we present a synopsis of the challenges, considerations, and potential controversies regarding veno-venous ECMO that will be of benefit to anesthesiologists, surgeons, and intensivists, especially those newly confronted with care of the ECMO patient. We outline a number of points related to ECMO, particularly regarding cannulation, pump/oxygenator design, anticoagulation, and intravascular fluid management of patients. We then address these challenges/considerations/controversies in the context of their potential future implications on clinical approaches to ECMO patients, focusing on the development and advancement of standardized ECMO clinical practices.

Summary: Since the 2009 H1N1 pandemic ECMO has gained a wider acceptance. There are challenges that still must be overcome. Further investigations of the benefits and effects of ECMO need to be undertaken in order to facilitate the implementation of this technology on a larger scale.

Keywords: Adult; Cannulation; ECMO; Respiratory distress syndrome; Veno-venous.

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Figures

**Figure 1**
**Examples of VV femoral cannulization. (A)** femoral-femoral connection; **(B)** femoral jugular connection.

**Figure 2**
**Example of ECMO ambulation:** **(A) extubated**, **bed**-**ridden patient on ECMO;** **(B) patient on ECMO and able to sit up in bed and ambulate.**

**Figure 3**
Maquet Cardiohelp portable device.

See this image and copyright information in PMC

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References

1. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R. Report of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination. J Crit Care. 1994;9(1):72–81. - PubMed
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1. Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–1304. - PubMed

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[1] Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R. Report of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination. J Crit Care. 1994;9(1):72–81. - PubMed

[2] Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R. Report of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination. J Crit Care. 1994;9(1):72–81. - PubMed

[3] Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353(16):1685–1693. - PubMed

[4] Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353(16):1685–1693. - PubMed

[5] Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365(20):1905–1914. - PubMed

[6] Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365(20):1905–1914. - PubMed

[7] Stapleton RD, Wang BM, Hudson LD, Rubenfeld GD, Caldwell ES, Steinberg KP. Causes and timing of death in patients with ARDS. Chest. 2005;128(2):525–532. - PubMed

[8] Stapleton RD, Wang BM, Hudson LD, Rubenfeld GD, Caldwell ES, Steinberg KP. Causes and timing of death in patients with ARDS. Chest. 2005;128(2):525–532. - PubMed

[9] Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–1304. - PubMed

[10] Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–1304. - PubMed

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Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies

Affiliations

Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies

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References

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