Newly Published
Review Article  |   March 2020
Extracorporeal Membrane Oxygenation for Respiratory Failure
Author Notes
  • From the Department of Anesthesiology and Intensive Care Medicine, University of Göttingen Medical Center, Göttingen, Germany (M.Q., M.B., L.G.); University of Michigan, Ann Arbor, Michigan (R.H.B.); Perioperative Medicine and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, United Kingdom (M.P.W.G.); Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France (A.C.); Service of Intensive Care, Institute of Cardiology, APHP Hôpital Pitié–Salpêtrière, Paris, France (A.C.); Alma Mater Studiorum – Department of Medical and Surgical Sciences, University of Bologna, Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Bologna, Italy (M.V.R., M.B.); Department of Clinical, Integrated, and Experimental Medicine (DIMES), Respiratory and Critical Care, Sant’Orsola Malpighi Hospital, Bologna, Italy (S.N.); Department of Medicine, Columbia University College of Physicians and Surgeons, and New York Presbyterian Medical Center, New York, New York (D.B.); Department of Adult Critical Care, Guy’s and St. Thomas’ NHS Foundation Trust, King’s Health Partners, and Division of Centre of Human Applied Physiological Sciences, King’s College London, London, United Kingdom (L.C., F.V.); Department of Pulmonary and Critical Care Medicine, Regions Hospital and University of Minnesota, Minneapolis/St. Paul, Minnesota (J.J.M.).
  • Submitted for publication January 29, 2019. Accepted for publication February 3, 2020.
    Submitted for publication January 29, 2019. Accepted for publication February 3, 2020.×
  • Correspondence: Address correspondence to Dr. Quintel: University of Göttingen Medical Center, Department of Anesthesiology and Intensive Care Medicine, Robert Koch Strasse 40, 37075 Göttingen, Germany. mquintel@med.uni-goettingen.de. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Review Article / Respiratory System
Review Article   |   March 2020
Extracorporeal Membrane Oxygenation for Respiratory Failure
Anesthesiology Newly Published on March 5, 2020. doi:https://doi.org/10.1097/ALN.0000000000003221
Anesthesiology Newly Published on March 5, 2020. doi:https://doi.org/10.1097/ALN.0000000000003221
Abstract

This review focuses on the use of veno-venous extracorporeal membrane oxygenation for respiratory failure across all blood flow ranges. Starting with a short overview of historical development, aspects of the physiology of gas exchange (i.e., oxygenation and decarboxylation) during extracorporeal circulation are discussed. The mechanisms of phenomena such as recirculation and shunt playing an important role in daily clinical practice are explained.

Treatment of refractory and symptomatic hypoxemic respiratory failure (e.g., acute respiratory distress syndrome [ARDS]) currently represents the main indication for high-flow veno-venous-extracorporeal membrane oxygenation. On the other hand, lower-flow extracorporeal carbon dioxide removal might potentially help to avoid or attenuate ventilator-induced lung injury by allowing reduction of the energy load (i.e., driving pressure, mechanical power) transmitted to the lungs during mechanical ventilation or spontaneous ventilation. In the latter context, extracorporeal carbon dioxide removal plays an emerging role in the treatment of chronic obstructive pulmonary disease patients during acute exacerbations. Both applications of extracorporeal lung support raise important ethical considerations, such as likelihood of ultimate futility and end-of-life decision-making. The review concludes with a brief overview of potential technical developments and persistent challenges.