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Critical Care
Published in: Critical Care 6/2009

Open Access 01-12-2009 | Research

A new miniaturized system for extracorporeal membrane oxygenation in adult respiratory failure

Authors: Thomas Müller, Alois Philipp, Andreas Luchner, Christian Karagiannidis, Thomas Bein, Michael Hilker, Leopold Rupprecht, Julia Langgartner, Markus Zimmermann, Matthias Arlt, Jan Wenger, Christof Schmid, Günter AJ Riegger, Michael Pfeifer, Matthias Lubnow

Published in: Critical Care | Issue 6/2009

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Abstract

Introduction

Mortality of severe acute respiratory distress syndrome in adults is still unacceptably high. Extracorporeal membrane oxygenation (ECMO) could represent an important treatment option, if complications were reduced by new technical developments.

Methods

Efficiency, side effects and outcome of treatment with a new miniaturized device for veno-venous extracorporeal gas transfer were analysed in 60 consecutive patients with life-threatening respiratory failure.

Results

A rapid increase of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) from 64 (48 to 86) mmHg to 120 (84 to 171) mmHg and a decrease of PaCO2 from 63 (50 to 80) mmHg to 33 (29 to 39) mmHg were observed after start of the extracorporeal support (P < 0.001). Gas exchange capacity of the device averaged 155 (116 to 182) mL/min for oxygen and 210 (164 to 251) mL/min for carbon dioxide. Ventilatory parameters were reduced to a highly protective mode, allowing a fast reduction of tidal volume from 495 (401 to 570) mL to 336 (292 to 404) mL (P < 0.001) and of peak inspiratory pressure from 36 (32 to 40) cmH2O to 31 (28 to 35) cmH2O (P < 0.001). Transfusion requirements averaged 0.8 (0.4 to 1.8) units of red blood cells per day. Sixty-two percent of patients were weaned from the extracorporeal system, and 45% survived to discharge.

Conclusions

Veno-venous extracorporeal membrane oxygenation with a new miniaturized device supports gas transfer effectively, allows for highly protective ventilation and is very reliable. Modern ECMO technology extends treatment opportunities in severe lung failure.
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Literature
1.
Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD: Incidence and outcomes of acute lung injury. N Engl J Med 2005, 353: 1685-1693. 10.1056/NEJMoa050333CrossRefPubMed
2.
Vasilyev S, Schaap RN, Mortensen JD: Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units: an international, multicenter, prospective survey. Chest 1995, 107: 1083-1088. 10.1378/chest.107.4.1083CrossRefPubMed
3.
Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Steward TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ: Characteristics and outcomes in adult patients receiving mechanical ventilation. JAMA 2002, 287: 345-355. 10.1001/jama.287.3.345CrossRefPubMed
4.
Brun-Buisson C, Minelli C, Bertolini G, Brazzi L, Pimentel J, Lewandowski K, Bion J, Romand JA, Villar J, Thorsteinsson A, Damas P, Armaganidis A, Lemaire F, for the ALIVE Study Group: Epidemiology and outcome of acute lung injury in European intensive care units. Intensive Care Med 2004, 30: 51-61. 10.1007/s00134-003-2022-6CrossRefPubMed
5.
Lewandowski K, Roissaint R, Pappert D, Gerlach H, Slama KJ, Weidemann H: High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation. Intensive Care Med 1997, 23: 819-835. 10.1007/s001340050418CrossRefPubMed
6.
Peek GJ, Moore HM, Moore N, Sosnowski AW, Firmin RK: Extracorporeal membrane oxygenation for adult respiratory failure. Chest 1997, 112: 759-764. 10.1378/chest.112.3.759CrossRefPubMed
7.
Hemmila MR, Rowe SA, Boules TN, Miskulin J, McGillicuddy JW, Schuerer DJ, Haft JW, Swaniker F, Arabi S, Hirschl RB, Bartlett RH: Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg 2004, 240: 595-607.PubMedCentralPubMed
8.
Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH, Morris AH, Peirce EC, Thomas AN, Proctor HJ, Drinker PA, Pratt PC, Bagniewski A, Miller RG: Extracorporeal membrane oxygenation in severe respiratory failure. A randomised prospective study. JAMA 1979, 242: 2193-2196. 10.1001/jama.242.20.2193CrossRefPubMed
9.
Morris AH, Fallace CJ, Menlove RL, Clemmer TP, Orme JF, Weaver LK, Dean NC, Thomas F, East TD, Pace NL, Suchyta MR, Beck E, Bombino M, Sittig DF, Böhm S, Hoffmann B, Becks H, Butler S, Pearl J, Rasmusson B: Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO 2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med 1994, 149: 295-305.CrossRefPubMed
10.
Horton S, Thuys C, Bennett M, Augustin S, Rosenberg M, Brizard C: Experience with the Jostra Rotaflow and Quadrox D oxygenator for ECMO. Perfusion 2004, 19: 17-23. 10.1191/0267659104pf702oaCrossRefPubMed
11.
Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, Pavie A, Chastre l: Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 2008, 36: 1404-1411. 10.1097/CCM.0b013e31816f7cf7CrossRefPubMed
12.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R: The American European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994, 149: 818-824.CrossRefPubMed
13.
Phua J, Badia JR, Adhikari NKJ, Friedrich JO, Fowler RA, Singh JM, Scales DC, Stather DR, Li A, Jones A, Gattas DJ, Hallett D, Tomlinson G, Stewart TE, Ferguson ND: Has mortality from acute respiratory distress syndrome decreased over time? A systematic review. Am J Respir Crit Care Med 2009, 179: 220-227. 10.1164/rccm.200805-722OCCrossRefPubMed
14.
Hill JD, O'Brien TG, Murray JJ, Doutigny L, Bramson ML, Osborn JJ, Gerbode F: Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med 1972, 286: 629-634.CrossRefPubMed
15.
Gattinoni L, Pesenti A, Mascheroni D, Marcolin R, Fumagalli R, Rossi F, Iapichino G, Romangnoli G, Uziel L, Agostoni A, Kolobow T, Damia G: Low-frequency positive-pressure ventilation with extracorporeal CO 2 removal in severe acute respiratory failure. JAMA 1986, 256: 881-886. 10.1001/jama.256.7.881CrossRefPubMed
16.
Mols G, Loop T, Geiger K, Farthmann E, Benzing A: Extracorporeal membrane oxygenation: a ten-year experience. Am J Surg 2000, 180: 144-154. 10.1016/S0002-9610(00)00432-3CrossRefPubMed
17.
Linden V, Palmer K, Reinhard J, Westmann R, Ehren H, Granholm T, Frencker B: High survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation. Intensive Care Med 2000, 26: 1630-1637. 10.1007/s001340000697CrossRefPubMed
18.
Beiderlinden M, Eikermann M, Boes T, Breitfeld C, Peters J: Treatment of severe acute respiratory distress syndrome: role of extracorporeal gas exchange. Intensive Care Med 2006, 32: 1627-1631. 10.1007/s00134-006-0262-yCrossRefPubMed
19.
Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RF, Elbourne D, CESAR trial collaboration: Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009, 374: 1351-1363. 10.1016/S0140-6736(09)61069-2CrossRefPubMed
20.
Brogan TV, Thiagarajan RR, Rycus PT, Bartlett RH, Bratton SL: Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med 2009, 35:-. 10.1007/s00134-009-1661-7CrossRef
21.
Kolla S, Awad SS, Rich PB, Schreiner RJ, Hirschl RB, Bartlett RH: Extracorporeal life support for 100 patients with severe respiratory failure. Ann Surg 1997, 226: 544-566. 10.1097/00000658-199710000-00015PubMedCentralCrossRefPubMed
22.
Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL: Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001, 286: 1754-1758. 10.1001/jama.286.14.1754CrossRefPubMed
23.
Müller T, Lubnow M, Philipp A, Bein T, Jeron A, Luchner A, Rupprecht L, Reng M, Langgartner J, Wrede CE, Zimmermann M, Birnbaum D, Schmid C, Riegger GAJ, Pfeifer M: Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy. Eur Respir J 2009, 33: 551-558. 10.1183/09031936.00123608CrossRefPubMed
24.
Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ: The CRIT Study: Anemia and blood transfusion in the critically ill - current clinical practice in the United States. Crit Care Med 2004, 32: 39-52. 10.1097/01.CCM.0000104112.34142.79CrossRefPubMed
25.
Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999, 340: 409-417. 10.1056/NEJM199902113400601CrossRefPubMed
26.
The Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000, 342: 1301-1308. 10.1056/NEJM200005043421801CrossRef
27.
Butch SH, Knafl P, Oberman HA, Bartlett RH: Blood utilization in adult patients undergoing extracorporeal membrane oxygenation therapy. Transfusion 1996, 36: 61-63. 10.1046/j.1537-2995.1996.36196190517.xCrossRefPubMed
28.
Ang AL, Teo D, Lim CH, Leou KK, Tien SL, Koh MBC: Blood transfusion requirements and independent predictors of increased transfusion requirements among adult patients on extracorporeal membrane oxygenation - a single centre experience. Vox Sanguinis 2009, 96: 34-43. 10.1111/j.1423-0410.2008.01110.xCrossRefPubMed
29.
Arlt M, Philipp A, Zimmermann M, Voelkel S, Hilker M, Hobbhahn J, Schmid C: First experiences with a new miniaturised life support system for mobile percutaneous cardiopulmonary bypass. Resuscitation 2008, 77: 345-350. 10.1016/j.resuscitation.2008.01.003CrossRefPubMed
Metadata
Title
A new miniaturized system for extracorporeal membrane oxygenation in adult respiratory failure
Authors
Thomas Müller
Alois Philipp
Andreas Luchner
Christian Karagiannidis
Thomas Bein
Michael Hilker
Leopold Rupprecht
Julia Langgartner
Markus Zimmermann
Matthias Arlt
Jan Wenger
Christof Schmid
Günter AJ Riegger
Michael Pfeifer
Matthias Lubnow
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc8213

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