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Extracorporeal support for patients with acute respiratory distress syndrome

European Respiratory Review. 2014;23(133):379-389 DOI 10.1183/09059180.00005514


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Journal Title: European Respiratory Review

ISSN: 0905-9180 (Print); 1600-0617 (Online)

Publisher: European Respiratory Society

LCC Subject Category: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML



Simon J. Finney


Peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 24 weeks


Abstract | Full Text

Extracorporeal membrane oxygen (ECMO) has been used for many years in patients with life-threatening hypoxaemia and/or hypercarbia. While early trials demonstrated that it was associated with poor outcomes and extensive haemorrhage, the technique has evolved. It now encompasses new technologies and understanding that the lung protective mechanical ventilation it can facilitate is inextricably linked to improving outcomes for patients. The positive results from the CESAR (Conventional ventilation or ECMO for Severe Adult Respiratory failure) study and excellent outcomes in patients who suffered severe influenza A (H1N1/09) infection have established ECMO in the care of patients with severe acute respiratory distress syndrome. Controversy remains as to at what point in the clinical pathway ECMO should be employed; as a rescue therapy or more pro-actively to enable and ensure high-quality lung protective mechanical ventilation. The primary aims of this article are to discuss: 1) the types of extracorporeal support available; 2) the rationale for its use; 3) the relationship with lung protective ventilation; and 4) the current evidence for its use.