Extracorporeal Membrane Oxygenation.
Journal
Deutsches Arzteblatt international
ISSN: 1866-0452
Titre abrégé: Dtsch Arztebl Int
Pays: Germany
ID NLM: 101475967
Informations de publication
Date de publication:
01 04 2022
01 04 2022
Historique:
received:
08
04
2021
revised:
08
04
2021
accepted:
25
11
2021
pubmed:
18
1
2022
medline:
6
7
2022
entrez:
17
1
2022
Statut:
ppublish
Résumé
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), also known as extracorporeal life support (ECLS), can both be used to treat patients with acute pulmonary or cardiovascular failure. This review is based on publications retrieved by a selective search in PubMed on the topics of cardiogenic shock and acute pulmonary failure, also known as the acute respiratory distress syndrome (ARDS), as well as on ECMO. Attention was given chiefly to randomized, controlled trials and guidelines. Initial findings from prospective, randomized trials of VV-ECMO are now available. Trials of ECLS therapy are now in progress or planned. A meta-analysis of two randomized, controlled trials of VV-ECMO for ARDS revealed more frequent survival 90 days after randomization among patients treated with VV-ECMO, compared to the control groups (36% vs. 48%; RR = 0.75 [95% confidence interval 0.6; 0.94]). For selected patients, after evaluation of the benefit-risk profile, VV-ECMO is a good treatment method for severe pulmonary failure, and ECLS for cardiogenic shock and resuscitation. The goal is to secure the circulation so that native heart function can be stabilized in the patient's further course or a permanent left-heart support system can be implanted, or else to support lung function until recovery. ECMO is a valid option in selected patients when conservative treatment has failed.
Sections du résumé
BACKGROUND
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), also known as extracorporeal life support (ECLS), can both be used to treat patients with acute pulmonary or cardiovascular failure.
METHODS
This review is based on publications retrieved by a selective search in PubMed on the topics of cardiogenic shock and acute pulmonary failure, also known as the acute respiratory distress syndrome (ARDS), as well as on ECMO. Attention was given chiefly to randomized, controlled trials and guidelines.
RESULTS
Initial findings from prospective, randomized trials of VV-ECMO are now available. Trials of ECLS therapy are now in progress or planned. A meta-analysis of two randomized, controlled trials of VV-ECMO for ARDS revealed more frequent survival 90 days after randomization among patients treated with VV-ECMO, compared to the control groups (36% vs. 48%; RR = 0.75 [95% confidence interval 0.6; 0.94]). For selected patients, after evaluation of the benefit-risk profile, VV-ECMO is a good treatment method for severe pulmonary failure, and ECLS for cardiogenic shock and resuscitation. The goal is to secure the circulation so that native heart function can be stabilized in the patient's further course or a permanent left-heart support system can be implanted, or else to support lung function until recovery.
CONCLUSION
ECMO is a valid option in selected patients when conservative treatment has failed.
Identifiants
pubmed: 35037618
pii: arztebl.m2022.0068
doi: 10.3238/arztebl.m2022.0068
pmc: PMC9342119
doi:
pii:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
235-244Commentaires et corrections
Type : CommentIn
Type : CommentIn
Références
Curr Opin Crit Care. 2019 Aug;25(4):391-396
pubmed: 31135393
Crit Care. 2015 Jan 22;19:19
pubmed: 25774818
J Card Surg. 2021 Apr;36(4):1344-1351
pubmed: 33547707
Lancet. 2020 Dec 5;396(10265):1807-1816
pubmed: 33197396
Respiration. 2019;98(4):357-372
pubmed: 31505511
Clin Res Cardiol. 2019 May;108(5):455-464
pubmed: 30361819
Am J Respir Crit Care Med. 2019 Oct 15;200(8):954-956
pubmed: 31216180
Circulation. 2018 Nov 13;138(20):2298-2300
pubmed: 30571518
Lancet. 2009 Oct 17;374(9698):1351-63
pubmed: 19762075
Eur J Cardiothorac Surg. 2019 Dec 1;56(6):1031-1036
pubmed: 31038672
Intensive Care Med. 2011 Sep;37(9):1447-57
pubmed: 21732167
JAMA. 2009 Nov 4;302(17):1888-95
pubmed: 19822628
EuroIntervention. 2021 Feb 05;16(15):e1227-e1236
pubmed: 33106225
ASAIO J. 2021 Apr 1;67(4):e86-e89
pubmed: 32701622
Intensive Care Med. 2016 May;42(5):889-896
pubmed: 26942446
Ann Thorac Surg. 2014 Feb;97(2):610-6
pubmed: 24210621
Am Heart J. 2021 Apr;234:1-11
pubmed: 33428901
J Crit Care. 2020 Jun;57:259-263
pubmed: 32061461
N Engl J Med. 2018 May 24;378(21):1965-1975
pubmed: 29791822
Curr Opin Crit Care. 2019 Jun;25(3):285-291
pubmed: 30865613
Ann Thorac Surg. 2019 Jan;107(1):311-321
pubmed: 29959943
Intensive Care Med. 2020 Nov;46(11):2048-2057
pubmed: 33021684
Ann Cardiothorac Surg. 2019 Jan;8(1):1-8
pubmed: 30854307
Eur Heart J. 2019 Aug 21;40(32):2671-2683
pubmed: 31274157
Circ Heart Fail. 2018 Sep;11(9):e004905
pubmed: 30354364
Med Klin Intensivmed Notfmed. 2021 Oct;116(7):605-608
pubmed: 33792739
Ann Thorac Surg. 2021 Jan;111(1):327-369
pubmed: 33036737
Circulation. 2020 Dec;142(22):2095-2106
pubmed: 33032450
J Thorac Dis. 2018 Mar;10(Suppl 5):S692-S697
pubmed: 29732188
Thorac Cardiovasc Surg. 2020 Aug;68(5):425-432
pubmed: 31207648
Crit Care. 2020 Jun 5;24(1):291
pubmed: 32503646
JAMA. 2018 Dec 4;320(21):2251-2259
pubmed: 30347031
Clin Transplant. 2013 Sep-Oct;27(5):E563-70
pubmed: 23898897
Crit Care. 2019 Nov 6;23(1):348
pubmed: 31694688
ASAIO J. 2018 Sep/Oct;64(5):689-693
pubmed: 29251631
Ann Intensive Care. 2017 Dec;7(1):51
pubmed: 28500585
Artif Organs. 2012 Aug;36(8):659-67
pubmed: 22817780
J Am Coll Cardiol. 2015 Dec 15;66(23):2663-2674
pubmed: 26670067