Extracorporeal membrane oxygenation for severe acute respiratory failure.docVIP

/content/4/3/156 Review Extracorporeal membrane oxygenation for severe acute respiratory failure Klaus Lewandowski Klinik für An?sthesiologie und operative Intensivmedizin, Charité, Campus Virchow-Klinikum, Berlin, Germany Received: 28 July 1999 Crit Care 2000,4:156–168 Revisions requested: 23 December 1999 Revisions received: 13 March 2000 Accepted: 16 March 2000 The electronic version of this article can be found online at /content/4/3/156 Published: 12 April 2000 ? Current Science Ltd Abstract Extracorporeal membrane oxygenatioon (ECMO) is a technique for providing life support, in case the natural lungs are failing and are not able to maintain a sufficient oxygenation of the body’s organ systems. ECMO technique was an adaptation of conventional cardiopulmonary bypass technique and introduced into treatment of severe acute respiratory distress syndrome (ARDS) in the 1970s. The initial reports of the use of ECMO in ARDS patients were quite enthusiastic, however, in the following years it became clear that ECMO was only of benefit in newborns with acute respiratory failure. In neonates treated with ECMO, survival rates of 80% could be achieved. In adult patients with ARDS, two large randomized controlled trials (RCTs) published in 1979 and 1994 failed to show an advantage of ECMO over convential treatment, survival rates were only 10% and 33%, respectively, in the ECMO groups. Since then, ECMO technology as well as conventional treatment of adult ARDS have undergone further improvements. In conventional treatment lung-protective ventilation strategies were introduced and ECMO was made safer by applying heparin-coated equipment, membranes and tubings. Many ECMO centres now use these advanced ECMO technology and report survival rates in excess of 50% in uncontrolled data collections. The question, however, of whether the improved ECMO can really challenge the advanced conventional treatment of adult ARDS is unanswered an