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Treating respiratory failure with extracorporeal support in the ICU 

Treating respiratory failure with extracorporeal support in the ICU
Chapter:
Treating respiratory failure with extracorporeal support in the ICU
Author(s):

Giacomo Bellani

and Antonio Pesenti

DOI:
10.1093/med/9780199600830.003.0105
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date: 25 February 2020

During extracorporeal support or extracorporeal membrane oxygenation (ECMO) blood is diverted from the patient to an artificial lung for gas exchange, then returned into the patient’s circulation once arterialized. While a low-blood-flow bypass can remove comparatively high amounts of CO2, oxygenation is limited by venous haemoglobin saturation and requires high flows. Several technical improvements led to a profound change in the safety and applicability of ECMO in recent years, even permitting the transfer of patients undergoing ECMO. ECMO has been proposed as salvage therapy for the most severe acute respiratory distress syndrome patients—warranting viable levels of oxygenation. In 2009, the ‘CESAR’ trial provided formal evidence in favour of ECMO application in adults with ARDS. An important indication for the early use of ECMO in ARDS came from the outbreaks of H1N1 influenza, when several countries set up networks aimed at coordinating the application of ECMO. Recent reports suggest the use of ECMO in less severe patients with the purpose of removing CO2, decreasing the need for ventilation and ventilator-induced lung injury,

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