Pulmonary complications associated with veno-arterial extra-corporeal membrane oxygenation: a comprehensive review.

Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving technology that provides transient respiratory and circulatory support for patients with profound cardiogenic shock or refractory cardiac arrest. Among its potential complications, VA-ECMO may adversely affect lung function through various pathophysiological mechanisms. The interaction of blood components with the biomaterials of the extracorporeal membrane elicits a systemic inflammatory response which may increase pulmonary vascular permeability and promote the sequestration of polymorphonuclear neutrophils within the lung parenchyma. Also, VA-ECMO increases the afterload of the left ventricle (LV) through reverse flow within the thoracic aorta, resulting in increased LV filling pressure and pulmonary congestion. Furthermore, VA-ECMO may result in long-standing pulmonary hypoxia, due to partial shunting of the pulmonary circulation and to reduced pulsatile blood flow within the bronchial circulation. Ultimately, these different abnormalities may result in a state of persisting lung inflammation and fibrotic changes with concomitant functional impairment, which may compromise weaning from VA-ECMO and could possibly result in long-term lung dysfunction. This review presents the mechanisms of lung damage and dysfunction under VA-ECMO and discusses potential strategies to prevent and treat such alterations.

• Authors: Aurélien Roumy, Lucas Liaudet, Marco Rusca, Carlo Marcucci, Matthias Kirsch
• Journal: Critical care (London, England) (Crit Care) Vol. 24 Issue 1 Pg. 212 (05 11 2020) ISSN: 1466-609X [Electronic] England
• PMID: 32393326 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Topics

• Humans
• Extracorporeal Membrane Oxygenation (adverse effects)
• Ischemia (etiology, physiopathology)
• Parenchymal Tissue (injuries, physiopathology)
• Respiratory Physiological Phenomena