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Review
. 2022 Sep;43(3):519-528.
doi: 10.1016/j.ccm.2022.05.006.

Extracorporeal Life Support in Respiratory Failure

Briana Short  1 , Kristin M Burkart  2
Affiliations
Review

Extracorporeal Life Support in Respiratory Failure

Briana Short et al. Clin Chest Med. 2022 Sep.

Abstract

Extracorporeal life support (ECLS) has a role in different types of respiratory failure including acute respiratory distress syndrome (ARDS), decompensated pulmonary hypertension, bridge to lung transplantation, and primary graft dysfunction after lung transplantation. ECLS in ARDS allows for lung-protective ventilation with the goal to reduce the risk of ventilator-induced lung injury. ECLS use in severe ARDS should be considered when conventional management strategies are not sufficient to safely support gas exchange. More research is needed to identify optimal mechanical ventilation during ECLS, weaning ECLS support, strategies for mobilization, sedation and anticoagulation, and long-term outcomes post-ECLS.

Keywords: Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO); Respiratory failure.

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Conflict of interest statement

Disclosure None.

Figures

Fig. 1
Fig. 1
Eligibility criteria for EOLIA: Criteria used to consider ECMO in severe ARDS. ARDS, acute respiratory distress syndrome; cmH2O, centimeters of water; FiO2, fraction of inspired oxygen; mm Hg, milliliter of mercury; Paco2, partial pressure of carbon dioxide; PaO2, partial pressure of oxygen; PEEP, positive-end expiratory pressures; VILI, ventilator-induced lung injury; VT, tidal volume.
Fig. 2
Fig. 2
Ventilator strategies for ECLS-supported ARDS: Best practice recommendations. Figure depicting recommended ventilator strategies for patients with ARDS requiring ECLS. Refer to text for reference citations. ARDS, acute respiratory distress syndrome; cmH2O, centimeters of water; ECLS, extracorporeal life support; ECMO, extracorporeal membrane oxygenation; FiO2, fraction of inspired oxygen; mL/Kg, milliliters per kilogram; NMBA, neuromuscular blockade; PBW, predicted body weight; PEEP, positive-end expiratory pressures; RR, respiratory rate.
Fig. 3
Fig. 3
Future directions. Figure depicting future directions in research and patient care for ECLS. ECLS, extracorporeal life support; ECMO, extracorporeal membrane oxygenation; PEEP, positive-end expiratory pressures; VILI, ventilator-induced lung injury.
See this image and copyright information in PMC

References

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