TY - JOUR
T1 - Adult veno-arterial extracorporeal life support
AU - Lescouflair, Tariq
AU - Figura, Ronald
AU - Tran, Anthony
AU - Kilic, Ahmet
N1 - Funding Information:
The 1940’s held the development of the artificial kidney by Dr. Willem Kolff. Interestingly, he was able to recognize that blood could be oxygenated as it passed through cellophane chambers. Dr. Gibbon later applied this property to the heart-lung machine in the 1950’s. With the 1960’s, the use of bubble oxygenators fell out of favor for membrane oxygenators in cardiopulmonary bypass. The method of oxygenation has evolved over the decades. Initially, “filmers” were used where blood was thinly spread out into vertical screens promoted oxygenation. Next, “bubblers” were used where blood in containers was mixed with bubbles of oxygen. Today, “membranes” consisting of hollow fibers allow blood to travel through an innumerable amount of thin tubes bathed in oxygen dense solution. Extracorporeal membrane oxygenation (ECMO) was in its infancy in the 1970s. At that time, the indication, applications, and outcomes remained relatively unknown. This led to large collaborative study involving nine hospitals sponsored by the National Heart, Lung, and Blood institute to research extracorporeal life support (ECLS) (1). This study found no difference in survival in adult patients with pulmonary insufficiency who had underwent ECMO therapy as compared to those treated with medical management. Unfortunately there were several problems associated with this study. First, many patients were entered into the study when lung damage had reached irreversible levels. Second, high-pressure ventilator support was continued in many patients thereby perpetuating the damage to lung parenchyma. Other studies in this decade showed similar results.
Publisher Copyright:
© Journal of Thoracic Disease.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Extracorporeal life support (ECLS)/extracorporeal membrane oxygenation (ECMO) is a powerful tool in the surgeon's armamentarium. The rapid evolution of ECLS over the last four decades has improved survival in patients with cardiopulmonary failure. With the pandemic outbreak of H1N1 in 2009 and onward, the application of ECLS has only risen. Yet, amongst the outcomes reporting and improved survival, the water remains hazy in terms of outcome predictors as well as discovery of the "ideal" system. There remains much room for innovation and research related to circuit construction, ideal flow, myocardial recovery, and additional applications of ECLS. We present a review on the topic of veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
AB - Extracorporeal life support (ECLS)/extracorporeal membrane oxygenation (ECMO) is a powerful tool in the surgeon's armamentarium. The rapid evolution of ECLS over the last four decades has improved survival in patients with cardiopulmonary failure. With the pandemic outbreak of H1N1 in 2009 and onward, the application of ECLS has only risen. Yet, amongst the outcomes reporting and improved survival, the water remains hazy in terms of outcome predictors as well as discovery of the "ideal" system. There remains much room for innovation and research related to circuit construction, ideal flow, myocardial recovery, and additional applications of ECLS. We present a review on the topic of veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
KW - Artificial ventilation
KW - Cardiopulmonary arrest
KW - Extracorporeal life support (ECLS)
KW - Extracorporeal membrane oxygenation (ECMO)
KW - Mechanical circulatory support
UR - http://www.scopus.com/inward/record.url?scp=85048888409&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048888409&partnerID=8YFLogxK
U2 - 10.21037/jtd.2018.01.25
DO - 10.21037/jtd.2018.01.25
M3 - Review article
C2 - 30034857
AN - SCOPUS:85048888409
SN - 2072-1439
VL - 10
SP - S1811-S1818
JO - Journal of Thoracic Disease
JF - Journal of Thoracic Disease
ER -