ECMO !
ECMO is a standard practice in neonatal and pediatric ICUs to support pulmonary failure but remained a very last resort in adult ICUs due to the high technical demands, cost, and risk of bleeding (required anticoagulation). The major reason ECMO remained unused in adult ICUs is a negative study done about 27 years ago. The National Institutes of Health trial of ECMO in severe acute respiratory failure in 1979 showed mortality in excess of 90%.
ECMO is a pulmonary version of CVVHD ! ECMO could be a bridge till definite therapy is sought or till healing occurs. Technically, VV or VA (veno-veno or veno-arterial) ECMO can provide sufficient oxygenation for several weeks.
The biggest advantage of ECMO in ARDS is the minimal requirement of positive pressure mechanical ventilation as you now need only little breaths with some tidal volume and PEEP, to prevent atelectasis. You rest the lung till healing occurs.
Is it time to think out of box again ?
Trial to watch: CESAR Trial - click - (Conventional ventilation or ECMO for Severe Adult Respiratory Failure) - The CESAR trial (180 patients) is closed now and results of the trial are known in late 2007.
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