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Critical Care of the Trauma Patient
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Facilitates gas exchange, especially carbon dioxide removal, by using the patient's own arterial pressure to pump blood through the circuit. The latter is sometimes referred to as an extracorporeal carbon dioxide removal (ECCO2R) system, as it is more efficient at CO2 removal than it is at correcting hypoxaemia. Low-flow VV-ECMO may also be used primarily for ECCO2R.
Recognition and Management of the Sick Child
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Julian Gaskin, Raymond W. Clarke, Claire Westrope
There are various subtypes of ECLS (with varying degrees of overlap) including: ECLA – extracorporeal lung-assisted systemsECMO – extracorporeal membrane oxygenation: a high-flow ECLS to replace lung and/or heart function, the term used synonymously with ECLSECCO2R – extracorporeal carbon dioxide removalECPR – extracorporeal cardiopulmonary resuscitation (emergency cardiac support in cardiac arrest). The principle of these techniques is that blood is drained from the circulation and reinfused back after passing through the extracorporeal circuit where it is oxygenated and carbon dioxide is removed.
Extracorporeal carbon dioxide removal for patients with acute respiratory failure: a systematic review and meta-analysis
Published in Annals of Medicine, 2023
Zhifeng Zhou, Zhengyan Li, Chen Liu, Fang Wang, Ling Zhang, Ping Fu
Acute respiratory failure (ARF) is a common clinical critical syndrome, which has a substantial mortality due to damage to the function of multiple organs, such as the heart, brain, and kidney. Acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD) are two major causes of ARF [1,2]. Currently, non-invasive ventilation (NIV) is a common therapy for the treatment of ARF. However, a great number of these patients will fail NIV and require invasive mechanical ventilation (IMV) [3], and evidence has shown that IMV with high tidal volume or high ventilation pressure can cause lung injury and increase mortality [4]. Low tidal volumes and limited plateau pressures have been confirmed to provide a survival advantage [5]. However, with concerns of progressive hypercapnia and potential adverse physiological consequences, low tidal volume ventilation is difficult to implement [6]. To solve this problem, a technique of artificial respiratory support called extracorporeal carbon dioxide removal (ECCO2R) that combines MV with extracorporeal life support has emerged.
Ventilator-induced lung injury during controlled ventilation in patients with acute respiratory distress syndrome: less is probably better
Published in Expert Review of Respiratory Medicine, 2018
Fernanda Ferreira Cruz, Lorenzo Ball, Patricia Rieken Macedo Rocco, Paolo Pelosi
In addition to its role as rescue therapy, extracorporeal support could be considered as a means of reducing VILI when keeping pressures and volumes below safe thresholds is not feasible. In particular, partial extracorporeal carbon dioxide removal (ECCO2R) reduces the minute ventilation required to avoid hypercapnia and acidosis, therefore potentially allowing least-injurious ventilation. Compared to ECMO, ECCO2R requires lower blood flows (0.4–1 L/m vs. 3–7 L/m), smaller cannulas, and is associated with fewer complications. It has been proposed to allow a reduction of VT and plateau pressure in milder cases of ARDS, when oxygenation can be acceptably maintained using the ventilator [98]. However, larger studies are still needed to clarify whether it can reduce mortality [99].
The acute respiratory distress syndrome: pathophysiology, current clinical practice, and emerging therapies
Published in Expert Review of Respiratory Medicine, 2018
Matthias Derwall, Lukas Martin, Rolf Rossaint
Supporting or replacing the pulmonary gas exchange has become increasingly feasible using technical means such as extracorporeal CO2 removal (ECCO2R) or extracorporeal membrane oxygenation (ECMO). However, both ECMO and ECCO2R should only be considered when lung protective ventilation is not possible, or if the patient experiences prolonged hypoxemia. While ECCO2R is used to bridge a patient suffering from hypercapnic lung failure, the more efficient, albeit more invasive ECMO is capable of supporting patients in both hypoxic- or combined- hypoxic/hypercapnic (‘global’) lung failure [55]. With its less invasive approach abundant experimental data and small clinical trials have proven the efficacy, safety and feasibility of low-flow extracorporeal carbon dioxide removal using ECCO2R in ARDS [56]. However, the ultimate long-term benefit for patients in ARDS remains less clear. Until now, clinical evidence from large prospective randomized clinical trials on ECCO2R in ARDS is lacking. As for ECMO, a randomized clinical trial by Peek and coworkers suggests that patients eligible for ECMO therapy profit from treatment in a center familiar with lung protective ventilation and eventually ECMO therapy as a rescue option [57]. Unfortunately, this study had an imbalance in its design for that only 70% in the control group received lung protective ventilation, while 93% of those transferred for possible ECMO received a lung-protective strategy [57]. However, the fact that transferring a patient to a dedicated ARDS-Facility carried an NNT of six to prevent one death nevertheless highlights the importance of treating patients presenting with lung failure in facilities familiar with all aspects of ARDS therapy. Another more recent landmark trial by Combes and colleagues [58] investigated the 60-day mortality in patients with severe ARDS on ECMO or on conventional lung protective ventilation. However, the EOLIA-trial was terminated early for futility after only 75% (n = 240) of the estimated study population were enrolled, and 60-day mortality was not significantly lower when patients were treated with ECMO (35% ECMO vs. 46% control; relative risk 0.76; 95% CI 0.55–1.04; p = 0.09). Due to the underestimated mortality in both treatment and control group during study design, another international multicenter RCT using the EOLIA-trial data to inform a conclusive study design has been suggested [59].