Extracorporeal Life Support in Adults with Acute Respiratory Failure: Current Evidence-Based Practices

Abstract

There has been rapid adoption of extracorporeal life support (ECLS) in adult patients with severe acute respiratory failure. Extracorporeal membrane oxygenation (ECMO) is used to rescue patients with severe hypoxemic and hypercapnic respiratory failure refractory to optimal therapy and extracorporeal carbon dioxide removal (ECCO2R) supports hypercapnic respiratory failure and allows very low tidal volume ventilation to minimize the risk of ventilator-induced lung injury. Currently over 3,000 cases of ECLS (ECMO and ECCO2R) in adults with respiratory failure are reported annually to the Extracorporeal Life Support Organization registry. Advances in the care of patients with acute respiratory distress syndrome, technological innovations in extracorporeal circuitry, and insights from modern clinical trials of ECLS have led to favorable outcomes and a renewed interest in the use of this technology. Significant gaps in knowledge about best practices remain, however. This review will summarize indications for respiratory support in adults, current evidence available from clinical trials and our institution's experience with adult respiratory ECLS.

Keywords: acute respiratory distress syndrome; extracorporeal carbon dioxide removal; extracorporeal life support; extracorporeal membrane oxygenation; low tidal volume ventilation.