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The clinical management of patients on partial/total extracorporeal support.

AbstractPURPOSE OF REVIEW:
Despite advances in extracorporeal membrane oxygenation (ECMO) technology, much is unknown about the optimal management strategies for patients receiving extracorporeal support. There is a growing body of literature investigating patient selection and outcomes, mechanical ventilation approaches, anticoagulation, pharmacokinetics, early mobilization, and the role of ECMO transport among others.
RECENT FINDINGS:
Nonrandomized data suggest a survival advantage from ECMO compared with conventional management in acute respiratory distress syndrome, with mechanical ventilation practices varying widely across centers. A randomized controlled trial is currently ongoing with standardized ventilation approaches in both arms. Low-level anticoagulation appears to be well tolerated, and ECMO circuitry appears to affect the pharmacokinetics of certain drugs. Pilot and matched cohort studies suggest that extracorporeal carbon dioxide removal is effective in preventing intubation in chronic obstructive pulmonary disease, with larger randomized studies being planned. ECMO may be successful in bridging selected patients to lung transplantation, with early mobilization serving as a well tolerated and effective means of optimizing these patients. Regionalization of ECMO may maximize outcomes and is facilitated by the development of ECMO transport teams.
SUMMARY:
Recently published data highlight the evolving management strategies of patients receiving extracorporeal support and help identify those patients most appropriate for ECMO and extracorporeal carbon dioxide removal. More data will ultimately be needed to develop an evidence-based consensus.
AuthorsDarryl Abrams, Daniel Brodie
JournalCurrent opinion in critical care (Curr Opin Crit Care) Vol. 22 Issue 1 Pg. 73-9 (Feb 2016) ISSN: 1531-7072 [Electronic] United States
PMID26645552 (Publication Type: Comparative Study, Journal Article, Review)
Chemical References
  • Anticoagulants
  • Carbon Dioxide
Topics
  • Anticoagulants (administration & dosage)
  • Carbon Dioxide (blood)
  • Critical Care (methods)
  • Critical Illness (mortality, therapy)
  • Disease Progression
  • Extracorporeal Membrane Oxygenation (methods)
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Positive-Pressure Respiration (methods)
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive (diagnosis, therapy)
  • Respiration, Artificial (methods)
  • Respiratory Distress Syndrome (diagnosis, mortality, therapy)
  • Respiratory Function Tests
  • Respiratory Insufficiency (diagnosis, mortality, therapy)
  • Survival Analysis
  • Treatment Outcome

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