PMID- 37721597
OWN - NLM
STAT- MEDLINE
DCOM- 20231023
LR  - 20231023
IS  - 2731-7099 (Electronic)
IS  - 2731-7080 (Linking)
VI  - 64
IP  - 10
DP  - 2023 Oct
TI  - [When mechanical ventilation fails-Venovenous extracorporeal membrane 
      oxygenation].
PG  - 922-931
LID - 10.1007/s00108-023-01586-y [doi]
AB  - Venovenous extracorporeal membrane oxygenation (VV-ECMO) is predominantly being 
      used as a rescue strategy in patients with acute lung failure, suffering from 
      severe oxygenation and/or decarboxylation impairment. Cannulas introduced into 
      the central veins lead blood through a membrane oxygenator in which it is 
      oxygenated via sweep gas (pO(2) up to 600 mm Hg) flow, eliminating CO(2). 
      According to the largest randomized studies carried out so far, the two most 
      important indications for VV-ECMO are hypoxic respiratory failure 
      (paO2 < 80 mm Hg for more than 6 h) and refractory hypercapnia (pH < 7.25 und 
      pCO(2) > 60 mm Hg with a breathing frequency of >30/min) despite optimal 
      protective mechanical ventilation settings (ARDS, Deltap < 14 mbar, plateau pressure 
      < 30 mbar, tidal volume V(T) < 6 ml/kg idealized body weight). Relative 
      contraindications are life-limiting comorbidities and terminal pulmonary diseases 
      that cannot be treated by lung transplantation. Advanced patient age is not 
      regarded as an absolute contraindication, though it highly impacts ARDS survival 
      rates, especially for pneumonia associated with coronavirus disease 2019 
      (COVID-19). The most frequent complications of VV-ECMO include bleeding, thrombus 
      formation and rare cases of cannula-associated infections. Its use in 
      nonintubated patients (awake ECMO) is possible in specific cases and has proven 
      valuable as a bridge to lung transplant approach. Some ECMO centers offer 
      cannulation of a patient at primary care hospitals, facilitating subsequent 
      transport to the center (ECMO transport). The COVID-19 pandemic not only caused 
      the number of VV-ECMO runs to skyrocket but has also drawn public attention to 
      this extracorporeal procedure. Strict quality control to improve vvECMO outcomes 
      according to the German hospital reform is urgently needed, especially so since 
      the technique has a high demand in resources and bears significant risks when 
      performed by untrained personnel.
CI  - (c) 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, 
      ein Teil von Springer Nature.
FAU - Mang, Sebastian
AU  - Mang S
AD  - Klinik fur Innere Medizin V - Pneumologie, Allergologie, Intensivmedizin, 
      Notfallmedizin, ECLS-Center Saar, Universitatsklinik des Saarlandes, Kirrberger 
      Str. 100, 66421, Homburg/Saar, Deutschland.
FAU - Karagiannidis, Christian
AU  - Karagiannidis C
AD  - Lungenklinik Koln-Merheim, Kliniken der Stadt Koln gGmbH, Koln, Deutschland.
AD  - Universitat Witten/Herdecke, Witten/Herdecke, Deutschland.
FAU - Lepper, Philipp M
AU  - Lepper PM
AD  - Klinik fur Innere Medizin V - Pneumologie, Allergologie, Intensivmedizin, 
      Notfallmedizin, ECLS-Center Saar, Universitatsklinik des Saarlandes, Kirrberger 
      Str. 100, 66421, Homburg/Saar, Deutschland. philipp.lepper@uks.eu.
LA  - ger
PT  - English Abstract
PT  - Journal Article
PT  - Review
TT  - Wenn maschinelle Beatmung nicht mehr ausreicht - venovenose extrakorporale 
      Membranoxygenierung.
DEP - 20230918
PL  - Germany
TA  - Inn Med (Heidelb)
JT  - Innere Medizin (Heidelberg, Germany)
JID - 9918384885306676
SB  - IM
MH  - Humans
MH  - Respiration, Artificial/adverse effects
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - *Respiratory Distress Syndrome/therapy
MH  - Pandemics
MH  - *COVID-19/therapy
OTO - NOTNLM
OT  - Acute respiratory distress syndrome
OT  - Bridge to transplant
OT  - Coronavirus disease 2019 (COVID-19)
OT  - Extracorporeal membrane oxygenation/quality control
OT  - Respiratory insufficiency
EDAT- 2023/09/18 12:43
MHDA- 2023/10/23 01:18
CRDT- 2023/09/18 11:05
PHST- 2023/08/14 00:00 [accepted]
PHST- 2023/10/23 01:18 [medline]
PHST- 2023/09/18 12:43 [pubmed]
PHST- 2023/09/18 11:05 [entrez]
AID - 10.1007/s00108-023-01586-y [pii]
AID - 10.1007/s00108-023-01586-y [doi]
PST - ppublish
SO  - Inn Med (Heidelb). 2023 Oct;64(10):922-931. doi: 10.1007/s00108-023-01586-y. Epub 
      2023 Sep 18.