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Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Cardiogenic Shock | Review

Pulmonary complications associated with veno-arterial extra-corporeal membrane oxygenation: a comprehensive review

Authors: Aurélien Roumy, Lucas Liaudet, Marco Rusca, Carlo Marcucci, Matthias Kirsch

Published in: Critical Care | Issue 1/2020

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Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving technology that provides transient respiratory and circulatory support for patients with profound cardiogenic shock or refractory cardiac arrest. Among its potential complications, VA-ECMO may adversely affect lung function through various pathophysiological mechanisms. The interaction of blood components with the biomaterials of the extracorporeal membrane elicits a systemic inflammatory response which may increase pulmonary vascular permeability and promote the sequestration of polymorphonuclear neutrophils within the lung parenchyma. Also, VA-ECMO increases the afterload of the left ventricle (LV) through reverse flow within the thoracic aorta, resulting in increased LV filling pressure and pulmonary congestion. Furthermore, VA-ECMO may result in long-standing pulmonary hypoxia, due to partial shunting of the pulmonary circulation and to reduced pulsatile blood flow within the bronchial circulation. Ultimately, these different abnormalities may result in a state of persisting lung inflammation and fibrotic changes with concomitant functional impairment, which may compromise weaning from VA-ECMO and could possibly result in long-term lung dysfunction. This review presents the mechanisms of lung damage and dysfunction under VA-ECMO and discusses potential strategies to prevent and treat such alterations.
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Metadata
Title
Pulmonary complications associated with veno-arterial extra-corporeal membrane oxygenation: a comprehensive review
Authors
Aurélien Roumy
Lucas Liaudet
Marco Rusca
Carlo Marcucci
Matthias Kirsch
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-02937-z

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