TY - CHAP M1 - Book, Section TI - Extracorporeal Lung Support A1 - Napolitano, Lena M. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - Extracorporeal membrane oxygenation (ECMO) can be used to provide support to selected patients with severe acute respiratory failure and severe hypoxemia.The two major ECMO modalities are veno-venous (VV) and veno-arterial (VA), but most cases of extracorporeal lung support use VV-ECMO.The prospective, randomized Adult ECMO study (CESAR trial) reported a 31% improved outcome in patients transported to a specialized center for possible ECMO (63% vs 47% survival without disability; relative risk 6-month death or severe disability 0.69, 95% CI 0.05-0.97; RR death 0.73, 95% CI 0.52-1.03).Significant adverse events and complications can occur during ECMO, most related to hemorrhage, but are becoming less common with improved technology and reduced anticoagulation requirements.ECMO is used in patients with severe hypoxemia related to ARDS, 2009 Influenza A (H1N1)–associated ARDS, trauma, and pulmonary embolus.Survival to discharge in adult patients receiving ECMO for respiratory failure is 52% from the Extracorporeal Life Support Organization (ELSO) registry.VV-ECMO is now being used as a therapeutic option to bridge patients with advanced lung disease to lung transplantation, avoiding the use of mechanical ventilation and allowing aggressive physical rehabilitation.A new adult ARDS ECMO multicenter clinical trial has been initiated, entitled ECM O to rescue Lung Injury in severe ARDS (EOLIA, Alain Combes MD, Principal Investigator, France).ECMO is a complex critical care organ support system, and requires an experienced and dedicated team, appropriate equipment, and institutional commitment and leadership.The current evidence supports the transfer of patients with severe hypoxemia and ARDS to institutions with significant experience in ARDS management and with ECMO capabilities. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/08 UR - accessmedicine.mhmedical.com/content.aspx?aid=1107718953 ER -