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Akoumianaki E, Jonkman A, Sklar MC, et al. A rational approach on the use of extracorporeal membrane oxygenation in severe hypoxemia: advanced technology is not a panacea. Ann Intensive Care. 2021;11(1):107doi: 10.1186/s13613-021-00897-3.
Akoumianaki, E., Jonkman, A., Sklar, M. C., Georgopoulos, D., & Brochard, L. (2021). A rational approach on the use of extracorporeal membrane oxygenation in severe hypoxemia: advanced technology is not a panacea. Annals of intensive care, 11(1), 107. https://doi.org/10.1186/s13613-021-00897-3
Akoumianaki, Evangelia, et al. "A rational approach on the use of extracorporeal membrane oxygenation in severe hypoxemia: advanced technology is not a panacea." Annals of intensive care vol. 11,1 (2021): 107. doi: https://doi.org/10.1186/s13613-021-00897-3
Akoumianaki E, Jonkman A, Sklar MC, Georgopoulos D, Brochard L. A rational approach on the use of extracorporeal membrane oxygenation in severe hypoxemia: advanced technology is not a panacea. Ann Intensive Care. 2021 Jul 12;11(1):107. doi: 10.1186/s13613-021-00897-3. PMID: 34250563; PMCID: PMC8273031.
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Ann Intensive Care. 2021 Jul 12;11(1):107. doi: 10.1186/s13613-021-00897-3.

A rational approach on the use of extracorporeal membrane oxygenation in severe hypoxemia: advanced technology is not a panacea.

Annals of intensive care

Evangelia Akoumianaki, Annemijn Jonkman, Michael C Sklar, Dimitris Georgopoulos, Laurent Brochard

Affiliations

  1. Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece.
  2. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
  3. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
  4. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. [email protected].
  5. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. [email protected].

PMID: 34250563 PMCID: PMC8273031 DOI: 10.1186/s13613-021-00897-3

Abstract

Veno-venous extracorporeal membrane oxygenation (ECMO) is a helpful intervention in patients with severe refractory hypoxemia either because mechanical ventilation cannot ensure adequate oxygenation or because lung protective ventilation is not feasible. Since ECMO is a highly invasive procedure with several, potentially devastating complications and its implementation is complex and expensive, simpler and less invasive therapeutic options should be first exploited. Low tidal volume and driving pressure ventilation, prone position, neuromuscular blocking agents and individualized ventilation based on transpulmonary pressure measurements have been demonstrated to successfully treat the vast majority of mechanically ventilated patients with severe hypoxemia. Veno-venous ECMO has a place in the small portion of severely hypoxemic patients in whom these strategies fail. A combined analysis of recent ARDS trials revealed that ECMO was used in only 2.15% of patients (n = 145/6736). Nevertheless, ECMO use has sharply increased in the last decade, raising questions regarding its thoughtful use. Such a policy could be harmful both for patients as well as for the ECMO technique itself. This narrative review attempts to describe together the practical approaches that can be offered to the sickest patients before going to ECMO, as well as the rationale and the limitations of ECMO. The benefit and the drawbacks associated with ECMO use along with a direct comparison with less invasive therapeutic strategies will be analyzed.

© 2021. The Author(s).

Keywords: ARDS; Extracorporeal membrane oxygenation; Lung protective ventilation; Prone position; Severe hypoxemia; VILI

References

  1. JAMA. 2010 Mar 3;303(9):865-73 - PubMed
  2. Crit Care Resusc. 2017 Oct;19(Suppl 1):37-44 - PubMed
  3. Chest. 2010 Apr;137(4):752-8 - PubMed
  4. Intensive Care Med. 2011 Sep;37(9):1447-57 - PubMed
  5. JAMA. 2009 Nov 4;302(17):1888-95 - PubMed
  6. Crit Care Med. 2014 May;42(5):1252-62 - PubMed
  7. CMAJ. 2014 Jul 8;186(10):E381-90 - PubMed
  8. Intensive Care Med. 2013 Oct;39(10):1704-13 - PubMed
  9. Ann Thorac Surg. 2021 Feb;111(2):537-543 - PubMed
  10. ASAIO J. 2020 Jul;66(7):722-730 - PubMed
  11. Crit Care Med. 2012 May;40(5):1578-85 - PubMed
  12. N Engl J Med. 2000 May 4;342(18):1301-8 - PubMed
  13. N Engl J Med. 2013 Jun 6;368(23):2159-68 - PubMed
  14. Am J Respir Crit Care Med. 2014 Mar 1;189(5):520-31 - PubMed
  15. Ann Am Thorac Soc. 2017 Oct;14(Supplement_4):S280-S288 - PubMed
  16. Pediatr Crit Care Med. 2017 Jan;18(1):73-79 - PubMed
  17. Ann Surg. 2020 Aug;272(2):e75-e78 - PubMed
  18. Intensive Care Med. 2020 Jun;46(6):1154-1169 - PubMed
  19. Lancet Respir Med. 2021 Apr 19;: - PubMed
  20. Crit Care Med. 2019 Apr;47(4):e332-e339 - PubMed
  21. Am J Respir Crit Care Med. 2021 Apr 23;: - PubMed
  22. Ann Thorac Surg. 2016 Feb;101(2):682-9 - PubMed
  23. Intensive Care Med. 2019 Nov;45(11):1590-1598 - PubMed
  24. Heart Lung. 2020 Jul - Aug;49(4):348-349 - PubMed
  25. Physiol Rev. 1984 Apr;64(2):544-616 - PubMed
  26. Intensive Care Med. 2018 Nov;44(11):1914-1922 - PubMed
  27. J Appl Physiol (1985). 1988 Jan;64(1):68-77 - PubMed
  28. Intensive Care Med. 2016 Aug;42(8):1264-6 - PubMed
  29. Crit Care. 2020 Apr 15;24(1):148 - PubMed
  30. Intensive Care Med. 2016 May;42(5):889-896 - PubMed
  31. JAMA. 2016 Feb 23;315(8):788-800 - PubMed
  32. N Engl J Med. 2019 May 23;380(21):1997-2008 - PubMed
  33. Intensive Care Med. 2016 May;42(5):897-907 - PubMed
  34. Am J Respir Crit Care Med. 2019 Oct 15;200(8):1002-1012 - PubMed
  35. Indian J Thorac Cardiovasc Surg. 2021 Apr;37(Suppl 2):303-308 - PubMed
  36. Crit Care Resusc. 2013 Sep;15(3):172-8 - PubMed
  37. Crit Care. 2016 Nov 28;20(1):387 - PubMed
  38. JAMA. 1979 Nov 16;242(20):2193-6 - PubMed
  39. Crit Care. 2017 Apr 4;21(1):84 - PubMed
  40. N Engl J Med. 2018 May 24;378(21):1965-1975 - PubMed
  41. N Engl J Med. 2004 Jul 22;351(4):327-36 - PubMed
  42. Intensive Care Med. 2012 Mar;38(3):395-403 - PubMed
  43. Am J Respir Crit Care Med. 1998 Jan;157(1):294-323 - PubMed
  44. Lancet Respir Med. 2019 Feb;7(2):163-172 - PubMed
  45. Am J Respir Crit Care Med. 2014 Jun 1;189(11):1374-82 - PubMed
  46. J Clin Virol. 2020 Jun;127:104364 - PubMed
  47. Intensive Care Med. 2017 Oct;43(10):1510-1511 - PubMed
  48. J Surg Res. 2021 Aug;264:81-89 - PubMed
  49. Crit Care. 2013 Mar 11;17(2):R43 - PubMed
  50. JAMA. 2018 Dec 4;320(21):2208-2210 - PubMed
  51. Am J Respir Crit Care Med. 2014 Feb 15;189(4):494-6 - PubMed
  52. Am J Respir Crit Care Med. 2014 Sep 1;190(5):488-96 - PubMed
  53. Intensive Care Med. 2016 Oct;42(10):1567-1575 - PubMed
  54. ASAIO J. 2021 May 1;67(5):496-502 - PubMed
  55. Am J Respir Crit Care Med. 2018 Apr 15;197(8):991-993 - PubMed
  56. JAMA. 2008 Feb 13;299(6):646-55 - PubMed
  57. J Physiol. 1914 Jul 14;48(4):244-71 - PubMed
  58. Am J Respir Crit Care Med. 2021 May 15;203(10):1266-1274 - PubMed
  59. Am J Respir Crit Care Med. 2019 Dec 1;200(11):1363-1372 - PubMed
  60. Trans Am Soc Artif Intern Organs. 1976;22:102-9 - PubMed
  61. J Crit Care. 2020 Dec;60:10-12 - PubMed
  62. Am J Respir Crit Care Med. 2020 Sep 2;: - PubMed
  63. Lancet. 2020 Oct 10;396(10257):1071-1078 - PubMed
  64. Anesthesiology. 2020 Oct 1;133(4):867-878 - PubMed
  65. J Card Surg. 2020 Jul;35(7):1410-1413 - PubMed
  66. Perfusion. 2014 Mar;29(2):139-41 - PubMed
  67. JAMA. 2019 Mar 5;321(9):846-857 - PubMed
  68. N Engl J Med. 1972 Mar 23;286(12):629-34 - PubMed
  69. Front Med (Lausanne). 2021 Jan 12;7:611460 - PubMed
  70. Eur J Cardiothorac Surg. 2010 Feb;37(2):339-42 - PubMed
  71. Am J Respir Crit Care Med. 2012 Apr 1;185(7):763-8 - PubMed
  72. Shock. 2021 Jan 20;: - PubMed
  73. Am J Respir Crit Care Med. 2021 Jul 1;204(1):34-43 - PubMed
  74. Am J Respir Crit Care Med. 2013 Feb 1;187(3):276-85 - PubMed
  75. ASAIO J. 2017 Sep/Oct;63(5):588-591 - PubMed
  76. Crit Care. 2020 May 15;24(1):225 - PubMed
  77. Ann Thorac Surg. 2019 May;107(5):1456-1463 - PubMed
  78. JAMA. 2017 Oct 10;318(14):1335-1345 - PubMed
  79. Am J Respir Crit Care Med. 2020 Jun 15;201(12):1525-1535 - PubMed
  80. Crit Care Med. 2019 Feb;47(2):186-193 - PubMed
  81. Intensive Care Med. 2018 Jan;44(1):22-37 - PubMed
  82. Anesthesiology. 2020 May;132(5):1257-1276 - PubMed
  83. ASAIO J. 2017 Jan/Feb;63(1):60-67 - PubMed
  84. ASAIO J. 2020 May;66(5):475-481 - PubMed
  85. Ann Intensive Care. 2012 Jul 26;2(1):33 - PubMed
  86. Lancet Respir Med. 2021 Apr 19;: - PubMed
  87. J Crit Care. 2021 Feb;61:221-226 - PubMed
  88. N Engl J Med. 1975 Feb 6;292(6):284-9 - PubMed
  89. Am J Respir Crit Care Med. 2017 May 1;195(9):1253-1263 - PubMed
  90. Am J Respir Crit Care Med. 2020 Aug 1;202(3):460-463 - PubMed
  91. N Engl J Med. 2020 Mar 12;382(11):999-1008 - PubMed
  92. Ann Thorac Surg. 2018 Dec;106(6):1668-1674 - PubMed
  93. JAMA. 2018 Dec 4;320(21):2251-2259 - PubMed
  94. Chest. 2015 Jun;147(6):1697-1703 - PubMed
  95. Crit Care Med. 2017 Oct;45(10):1726-1733 - PubMed
  96. Crit Care. 2019 Nov 6;23(1):348 - PubMed
  97. Ann Intensive Care. 2019 Jun 13;9(1):69 - PubMed
  98. J Intensive Care Med. 2017 May;32(4):243-248 - PubMed
  99. N Engl J Med. 2010 Sep 16;363(12):1107-16 - PubMed
  100. N Engl J Med. 2020 Mar 12;382(11):989-998 - PubMed
  101. Crit Care Med. 2019 Oct;47(10):1346-1355 - PubMed
  102. N Engl J Med. 2015 Feb 19;372(8):747-55 - PubMed
  103. Crit Care. 2019 Apr 23;23(1):133 - PubMed
  104. Lancet Respir Med. 2020 Nov;8(11):1121-1131 - PubMed
  105. ASAIO J. 2015 Mar-Apr;61(2):115-21 - PubMed
  106. Crit Care Med. 2017 Aug;45(8):1389-1397 - PubMed
  107. JAMA. 2008 Feb 13;299(6):637-45 - PubMed
  108. N Engl J Med. 2001 Aug 23;345(8):568-73 - PubMed
  109. Lancet. 2009 Oct 17;374(9698):1351-63 - PubMed
  110. Crit Care Med. 2018 Sep;46(9):1506-1513 - PubMed
  111. Intensive Care Med. 2017 Aug;43(8):1162-1163 - PubMed
  112. Lancet Respir Med. 2019 Oct;7(10):870-880 - PubMed
  113. Intensive Care Med. 2009 Nov;35(11):1850-8 - PubMed
  114. Intensive Care Med. 2015 Sep;41(9):1714-5 - PubMed
  115. Lancet Respir Med. 2020 Sep;8(9):905-913 - PubMed
  116. JAMA. 2011 Oct 19;306(15):1659-68 - PubMed
  117. PLoS One. 2014 Dec 02;9(12):e112316 - PubMed
  118. Crit Care Med. 2008 Aug;36(8):2373-80 - PubMed
  119. JAMA Surg. 2020 Oct 1;155(10):990-992 - PubMed
  120. Crit Care. 2020 Jan 15;24(1):4 - PubMed
  121. N Engl J Med. 2008 Nov 13;359(20):2095-104 - PubMed
  122. Nephrol Dial Transplant. 2013 Jan;28(1):86-90 - PubMed
  123. Am J Respir Crit Care Med. 2020 Jun 1;201(11):1430-1434 - PubMed
  124. JAMA Netw Open. 2019 Jul 3;2(7):e198116 - PubMed
  125. J Crit Care. 2020 Aug;58:27-28 - PubMed
  126. Crit Care Med. 2020 Feb;48(2):192-199 - PubMed

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