Abstract
Despite the breadth of life-sustaining interventions available, mortality in patients
with acute respiratory distress syndrome (ARDS) remains high. A greater appreciation
of the potential iatrogenic injury associated with the use of mechanical ventilation
has led clinicians and researchers to seek alternatives. Extracorporeal life support
(ECLS) may be used to rescue patients with severely impaired gas exchange and provide
time for injured lungs to recover while treating the underlying disease. In patients
with ARDS, venovenous (VV) ECLS is commonly used, where venous blood is drained into
a circuit that passes through a membrane lung, which provides gas exchange, and then
returned to the venous system. VV-ECLS can be configured as a system that uses higher
blood flows with extracorporeal membrane oxygenation (VV-ECMO) or as one that uses
lower blood flows for extracorporeal carbon dioxide removal (VV-ECCO2R). Recent studies support the use of VV-ECMO in patients with severe ARDS who present
with refractory gas exchange despite the use of lung-protective mechanical ventilation,
positive end-expiratory pressure optimization, neuromuscular blockade, and prone positioning.
The optimal management of patients during ECLS (i.e., anticoagulation, transfusions,
mechanical ventilation) and the role of ECCO2R in the management of ARDS remain to be determined.
Keywords
extracorporeal membrane oxygenation - extracorporeal life support - ventilator-induced
lung injury - acute respiratory distress syndrome
