Alain Combes1,2, Dan Brodie3, Yih-Sharng Chen4, Eddy Fan5,6, José P S Henriques7, Carol Hodgson8, Philipp M Lepper9, Pascal Leprince10,11, Kunihiko Maekawa12, Thomas Muller13, Sebastian Nuding14, Dagmar M Ouweneel7, Antoine Roch15, Matthieu Schmidt16,10, Hiroo Takayama17, Alain Vuylsteke18, Karl Werdan14, Laurent Papazian15. 1. Medical-Surgical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, F-75013, Paris, France. alain.combes@aphp.fr. 2. Institute of Cardiometabolism and Nutrition, Sorbonne University, UPMC Univ Paris 06, INSERM, UMRS_1166-ICAN, F-75013, Paris, France. alain.combes@aphp.fr. 3. Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, Columbia University, New York, NY, USA. 4. Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan. 5. Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 6. Extracorporeal Life Support Program, Toronto General Hospital, Toronto, Ontario, Canada. 7. AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands. 8. ANZIC-RC, Department of Epidemiology and Preventive Medicine, Monash University and Physiotherapy Department, The Alfred, Melbourne, Australia. 9. Department of Internal Medicine V-Pneumology and Critical Care Medicine, ECLS Centre Saar, University Hospital of Saarland, Homburg, Germany. 10. Institute of Cardiometabolism and Nutrition, Sorbonne University, UPMC Univ Paris 06, INSERM, UMRS_1166-ICAN, F-75013, Paris, France. 11. Cardiothoracic and Vascular Surgery Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, F-75013, Paris, France. 12. Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Japan. 13. Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. 14. Department of Medicine III, University Hospital Halle (Saale) of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany. 15. Réanimation des Détresses Respiratoires et Infections Sévères, CHU Nord, UMR CNRS 7278, Aix-Marseille Université, Marseille, France. 16. Medical-Surgical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, F-75013, Paris, France. 17. Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA. 18. Papworth Hospital NHS Foundation Trust, Papworth, UK.
Abstract
PURPOSE: This study aimed to concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to extracorporeal membrane oxygenation (ECMO). METHODS: Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion. RESULTS: The use of venovenous ECMO (VV-ECMO) is increasing in the most severe forms of acute lung injury. In patients with cardiogenic shock, short-term veno-arterial ECMO (VA-ECMO) provides both pulmonary and circulatory support. Technological improvements and recently published studies suggest that ECMO is able to improve patients' outcomes. There are, however, many uncertainties regarding the real benefits of this technique both in hemodynamic and respiratory failure, the territorial organization to deliver ECMO, the indications and the use of concomitant treatments. CONCLUSIONS: Although there have been considerable advances regarding the use of ECMO in critically ill patients, the risk/benefit ratio remains underinvestigated. ECMO indications, organization of ECMO delivery, and use of adjuvant therapeutics need also to be explored. Ongoing and future studies may be able to resolve these issues.
PURPOSE: This study aimed to concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to extracorporeal membrane oxygenation (ECMO). METHODS: Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion. RESULTS: The use of venovenous ECMO (VV-ECMO) is increasing in the most severe forms of acute lung injury. In patients with cardiogenic shock, short-term veno-arterial ECMO (VA-ECMO) provides both pulmonary and circulatory support. Technological improvements and recently published studies suggest that ECMO is able to improve patients' outcomes. There are, however, many uncertainties regarding the real benefits of this technique both in hemodynamic and respiratory failure, the territorial organization to deliver ECMO, the indications and the use of concomitant treatments. CONCLUSIONS: Although there have been considerable advances regarding the use of ECMO in critically illpatients, the risk/benefit ratio remains underinvestigated. ECMO indications, organization of ECMO delivery, and use of adjuvant therapeutics need also to be explored. Ongoing and future studies may be able to resolve these issues.
Entities:
Keywords:
Acute respiratory distress syndrome; Cardiogenic shock; Extracorporeal membrane oxygenation; Position article; Research agenda
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