Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era
Identifieur interne : 005D60 ( Main/Exploration ); précédent : 005D59; suivant : 005D61Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era
Auteurs : Graeme Maclaren [Singapour, Australie] ; Alain Combes [France] ; Robert H. Bartlett [États-Unis]Source :
- Intensive care medicine : (Print) [ 0342-4642 ] ; 2012.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) has been used in clinical medicine for 40 years but remains controversial therapy, particularly in adult patients with severe respiratory failure. Over the last few years, there have been considerable advances in extracorporeal technology and clinical practice, ushering in a new era of ECMO. Many institutions adopted ECMO as rescue therapy during the recent H1N1 influenza pandemic, reigniting the controversy. Discussion: Hollow-fibre oxygenators and Mendler-designed centrifugal pumps have replaced the old silicon oxygenators and roller pumps. The advantages of these novel systems and the principles that underlie their function are outlined. Advances in cannula technology allow greater ease of patient positioning, in some cases facilitating extubation and ambulation on ECMO. Improvements in ECMO circuitry have led to a reduction in heparin and blood product requirements, with consequently fewer complications. Greater understanding of severe acute respiratory distress syndrome has allowed clinicians to successfully support adults on ECMO for months at a time, as a bridge to either recovery or transplantation. Conclusions: ECMO is safer, cheaper, and simpler than in previous eras. Both circuit and patient can be cared for by a single trained nurse. Additional prospective studies of ECMO for adult respiratory failure are underway. Contemporary ECMO in awake, potentially ambulant patients to provide short-term support for those with acute, reversible respiratory failure and as a bridge to transplantation in those with irreversible respiratory failure is now ready for widespread evaluation.
Affiliations:
- Australie, France, Singapour, États-Unis
- Victoria (État), Île-de-France
- Melbourne, Paris
- Université Pierre-et-Marie-Curie
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Bartlett</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>University of Michigan</s1><s2>Ann Arbor, MI</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Michigan</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">12-0122745</idno><date when="2012">2012</date><idno type="stanalyst">PASCAL 12-0122745 INIST</idno><idno type="RBID">Pascal:12-0122745</idno><idno type="wicri:Area/PascalFrancis/Corpus">001549</idno><idno type="wicri:Area/PascalFrancis/Curation">004963</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">001242</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">001242</idno><idno type="wicri:doubleKey">0342-4642:2012:Maclaren G:contemporary:extracorporeal:membrane</idno><idno type="wicri:Area/Main/Merge">006077</idno><idno type="wicri:Area/Main/Curation">005D60</idno><idno type="wicri:Area/Main/Exploration">005D60</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era</title><author><name sortKey="Maclaren, Graeme" sort="Maclaren, Graeme" uniqKey="Maclaren G" first="Graeme" last="Maclaren">Graeme Maclaren</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Cardiothoracic ICU, National University Hospital, 5 Lower Kent Ridge Rd</s1><s2>Singapore 119074</s2><s3>SGP</s3><sZ>1 aut.</sZ></inist:fA14><country>Singapour</country><wicri:noRegion>Singapore 119074</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Paediatric ICU, Royal Children's Hospital</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>1 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Combes, Alain" sort="Combes, Alain" uniqKey="Combes A" first="Alain" last="Combes">Alain Combes</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Service de Reanimation Medicale, Groupe Hospitalier Pitie-Salpetriere, Universite Pierre et Marie Curie, Paris 6</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Pierre-et-Marie-Curie</orgName></affiliation></author><author><name sortKey="Bartlett, Robert H" sort="Bartlett, Robert H" uniqKey="Bartlett R" first="Robert H." last="Bartlett">Robert H. Bartlett</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>University of Michigan</s1><s2>Ann Arbor, MI</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of Michigan</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Intensive care medicine : (Print)</title><title level="j" type="abbreviated">Intensive care med. : (Print)</title><idno type="ISSN">0342-4642</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Intensive care medicine : (Print)</title><title level="j" type="abbreviated">Intensive care med. : (Print)</title><idno type="ISSN">0342-4642</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>H1N1 influenza</term><term>Intensive care</term><term>Mechanical ventilation</term><term>Oxygenation</term><term>Respiratory distress</term><term>Respiratory failure</term><term>Respiratory support</term><term>Resuscitation</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Insuffisance respiratoire</term><term>Détresse respiratoire</term><term>Oxygénation</term><term>Assistance respiratoire</term><term>Ventilation mécanique</term><term>Réanimation</term><term>Soin intensif</term><term>Grippe H1N1</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Extracorporeal membrane oxygenation (ECMO) has been used in clinical medicine for 40 years but remains controversial therapy, particularly in adult patients with severe respiratory failure. Over the last few years, there have been considerable advances in extracorporeal technology and clinical practice, ushering in a new era of ECMO. Many institutions adopted ECMO as rescue therapy during the recent H1N1 influenza pandemic, reigniting the controversy. Discussion: Hollow-fibre oxygenators and Mendler-designed centrifugal pumps have replaced the old silicon oxygenators and roller pumps. The advantages of these novel systems and the principles that underlie their function are outlined. Advances in cannula technology allow greater ease of patient positioning, in some cases facilitating extubation and ambulation on ECMO. Improvements in ECMO circuitry have led to a reduction in heparin and blood product requirements, with consequently fewer complications. Greater understanding of severe acute respiratory distress syndrome has allowed clinicians to successfully support adults on ECMO for months at a time, as a bridge to either recovery or transplantation. Conclusions: ECMO is safer, cheaper, and simpler than in previous eras. Both circuit and patient can be cared for by a single trained nurse. Additional prospective studies of ECMO for adult respiratory failure are underway. Contemporary ECMO in awake, potentially ambulant patients to provide short-term support for those with acute, reversible respiratory failure and as a bridge to transplantation in those with irreversible respiratory failure is now ready for widespread evaluation.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Singapour</li><li>États-Unis</li></country><region><li>Victoria (État)</li><li>Île-de-France</li></region><settlement><li>Melbourne</li><li>Paris</li></settlement><orgName><li>Université Pierre-et-Marie-Curie</li></orgName></list><tree><country name="Singapour"><noRegion><name sortKey="Maclaren, Graeme" sort="Maclaren, Graeme" uniqKey="Maclaren G" first="Graeme" last="Maclaren">Graeme Maclaren</name></noRegion></country><country name="Australie"><region name="Victoria (État)"><name sortKey="Maclaren, Graeme" sort="Maclaren, Graeme" uniqKey="Maclaren G" first="Graeme" last="Maclaren">Graeme Maclaren</name></region></country><country name="France"><region name="Île-de-France"><name sortKey="Combes, Alain" sort="Combes, Alain" uniqKey="Combes A" first="Alain" last="Combes">Alain Combes</name></region></country><country name="États-Unis"><noRegion><name sortKey="Bartlett, Robert H" sort="Bartlett, Robert H" uniqKey="Bartlett R" first="Robert H." last="Bartlett">Robert H. 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