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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2014

Open Access 01-12-2014 | Debate

Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies

Authors: David B Tulman, Stanislaw P A Stawicki, Bryan A Whitson, Saarik C Gupta, Ravi S Tripathi, Michael S Firstenberg, Don Hayes Jr, Xuzhong Xu, Thomas J Papadimos

Published in: BMC Anesthesiology | Issue 1/2014

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Abstract

Background

Following the 2009 H1N1 Influenza pandemic, extracorporeal membrane oxygenation (ECMO) emerged as a viable alternative in selected, severe cases of ARDS. Acute Respiratory Distress Syndrome (ARDS) is a major public health problem. Average medical costs for ARDS survivors on an annual basis are multiple times those dedicated to a healthy individual. Advances in medical and ventilatory management of severe lung injury and ARDS have improved outcomes in some patients, but these advances fail to consistently “rescue” a significant proportion of those affected.

Discussion

Here we present a synopsis of the challenges, considerations, and potential controversies regarding veno-venous ECMO that will be of benefit to anesthesiologists, surgeons, and intensivists, especially those newly confronted with care of the ECMO patient. We outline a number of points related to ECMO, particularly regarding cannulation, pump/oxygenator design, anticoagulation, and intravascular fluid management of patients. We then address these challenges/considerations/controversies in the context of their potential future implications on clinical approaches to ECMO patients, focusing on the development and advancement of standardized ECMO clinical practices.

Summary

Since the 2009 H1N1 pandemic ECMO has gained a wider acceptance. There are challenges that still must be overcome. Further investigations of the benefits and effects of ECMO need to be undertaken in order to facilitate the implementation of this technology on a larger scale.
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Metadata
Title
Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies
Authors
David B Tulman
Stanislaw P A Stawicki
Bryan A Whitson
Saarik C Gupta
Ravi S Tripathi
Michael S Firstenberg
Don Hayes Jr
Xuzhong Xu
Thomas J Papadimos
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2014
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-14-65

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