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Review
. 2017 Jan-Feb;43(1):60-70.
doi: 10.1590/S1806-37562016000000299.

Extracorporeal respiratory support in adult patients

[Article in English, Portuguese]
Thiago Gomes Romano  1   2 , Pedro Vitale Mendes  3   2 , Marcelo Park  3 , Eduardo Leite Vieira Costa  2   4
Affiliations
Review

Extracorporeal respiratory support in adult patients

[Article in English, Portuguese]
Thiago Gomes Romano et al. J Bras Pneumol. 2017 Jan-Feb.

Abstract
in English, Portuguese, Portuguese

In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO), which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support. We discuss the history of respiratory support using ECMO in adults, as well as the clinical evidence; costs; indications; installation of the equipment; ventilator settings; daily care of the patient and the system; common troubleshooting; weaning; and discontinuation.

Em pacientes com insuficiência respiratória grave (hipoxêmica ou hipercápnica), o suporte somente com ventilação mecânica pode ser insuficiente para suas necessidades, especialmente quando se tenta evitar o uso de parâmetros ventilatórios que possam causar danos aos pulmões. Nesses pacientes, extracorporeal membrane oxygenation (ECMO, oxigenação extracorpórea por membrana), que também é muito eficaz na remoção de dióxido de carbono do sangue, pode manter a vida, permitindo o uso de ventilação pulmonar protetora. No presente artigo de revisão, objetivamos explorar alguns dos aspectos mais relevantes do suporte respiratório por ECMO. Discutimos a história do suporte respiratório por ECMO em adultos; evidências clínicas; custos; indicações; instalação do equipamento; parâmetros ventilatórios; cuidado diário do paciente e do sistema; solução de problemas comuns; desmame e descontinuação.

Em pacientes com insuficiência respiratória grave (hipoxêmica ou hipercápnica), o suporte somente com ventilação mecânica pode ser insuficiente para suas necessidades, especialmente quando se tenta evitar o uso de parâmetros ventilatórios que possam causar danos aos pulmões. Nesses pacientes, extracorporeal membrane oxygenation (ECMO, oxigenação extracorpórea por membrana), que também é muito eficaz na remoção de dióxido de carbono do sangue, pode manter a vida, permitindo o uso de ventilação pulmonar protetora. No presente artigo de revisão, objetivamos explorar alguns dos aspectos mais relevantes do suporte respiratório por ECMO. Discutimos a história do suporte respiratório por ECMO em adultos; evidências clínicas; custos; indicações; instalação do equipamento; parâmetros ventilatórios; cuidado diário do paciente e do sistema; solução de problemas comuns; desmame e descontinuação.

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Figures

Figure 1
Figure 1. Basic extracorporeal membrane oxygenation (ECMO) configurations. Panel A shows the venovenous ECMO configuration, in which the extracorporeal system is in series with the lungs, providing only respiratory support. Panel B shows the venoarterial ECMO configuration, in which the extracorporeal system is in parallel with the heart and lungs, providing respiratory and cardiovascular support.
Figure 2
Figure 2. Venovenous extracorporeal membrane oxygenation (ECMO) configuration and possible connections with a hemofilter, with or without a dialysis machine. The drainage cannula is inserted into the femoral vein and advanced up to the inferior vena cava (IVC), whereas the return cannula is inserted into the internal jugular vein and advanced up to the superior vena cava (SVC). In this example, blood is drained by the suctioning action of a centrifugal pump into the negative-pressure side of the extracorporeal circuit. Downstream of the pump, blood is propelled into the positive-pressure side of the circuit, crosses the oxygenator, and is returned to the SVC. The dashed lines indicate different possibilities of connection to a hemofilter-downstream of the oxygenator (path A); downstream of the pump and upstream of the oxygenator (path B); upstream of the ECMO pump (path C); downstream of the ECMO pump (positive-pressure side, path D); and upstream of the ECMO pump (negative-pressure side, path E)-in patients requiring simultaneous renal replacement therapy.
Figure 3
Figure 3. An X-ray of the chest (taken with a portable X-ray machine at the bedside) of a patient with hypoxemic respiratory failure submitted to extracorporeal membrane oxygenation support. Note the positioning of the cannulas (dashed lines) with their tips (arrows) in close proximity, which may favor the occurrence of recirculation.
See this image and copyright information in PMC

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