Extracorporeal membrane oxygenation (ECMO) can be used for the treatment of acute respiratory failure. Based on recent experience in establishing such a method of treatment, this paper reviews those aspects of ECMO that need careful consideration before it can be undertaken. Methods of patient selection for ECMO and the physiological changes associated with it are also discussed.
References
1.
AshmoreP. G., SvitekV., and AmbroseP. (1968): “The Incidence and Effects of Particulate Aggregation and Microembolism in Pump-oxygenator Systems”, J. Thorac. Cardiovasc. Surg., 55, 691.
2.
AwadJ., FortinB., BernierJ-P., and LeclercR. (1974): “Red Blood Cell Survival After Perfusion with Membrane Oxygenator”, Amer. J. Surg., 127, 535.
3.
AwadJ. A., MatteJ., and BrassardA. (1973): “Prolonged Extracorporeal Respiration with a Membrane Gas Exchanger”, J. Thorac. Cardiovasc. Surg., 66, 40.
4.
BaezaO. R., WagnerR. B., and LoweryB. D. (1975): “Pulmonary Hyperinflation. A Form of Barotrauma During Mechanical Ventilation”, J. Thorac. Cardiovasc. Surg., 70, 790.
5.
BartlettR. H., FongS. W., and BurnsN. E. (1974): “Prolonged Partial Veno-arterial Bypass. Physiological, Biochemical and Haematological Responses”, Ann. Surg., 180, 850.
6.
BartlettR. H., GazzanigaA., FongS. W., and BurnsN. E. (1974): “Prolonged Extracorporeal Cardiopulmonary Support in Man”, J. Thorac. Cardiovasc. Surg., 68, 918.
7.
BeattieH. W., EvansG., GarnettE. S., RegoecziE., WebberC. E., and WongK. L. (1974): “Albumin and Water Fluxes During Cardiopulmonary Bypass”, J. Thorac. Cardiovasc. Surg., 67, 926.
8.
BeattieH. W., EvansG., GarnettE. S., and WebberC. E. (1972): “Sustained Hypovolaemia and Extracellular Fluid Volume Expansion Following Cardiopulmonary Bypass”, Surgery, 71, 891.
9.
BeekenW. E., VolwilerW., GoldsworthyP. O., GarbyE. E., ReynoldsW. E., StogsdillR., and StemlerR. S. (1962): “Studies of 1131 Albumin Catabolism and Distribution in Normal Young Adult Males”, J. Clin. Invest., 41, 1312.
BoucherJ. K., RudyE. W., and EdmundsE. H. Jr. (1974): “Organ Blood Flow During Pulsatile Cardiopulmonary Bypass”, J. Appl. Physiol., 36, 80.
12.
BrinsfieldD., HopfM. A., MayerS. E., and GallettiF. (1964): “Body Fluids and Electrolytes After Prolonged Cardiopulmonary Bypass”, J. Appl. Physiol., 19, 566.
13.
BuleyR., and LumleyJ. (1975): “Some Observations on Blood Microfilters”, Ann. R. Coll. Surg. Engl57, 262.
14.
CarlsonR. G., LandeA. J., LandisB., RogozB., BaxterJ., PattersonR. H., StenzelK., and LilleheiC. W. (1973): “The Lande-Edwards Membrane Oxygenator During Heart Surgery. Oxygen Transfer, Microemboli Counts, Bender-Gestalt Visual Motor Scores”, J. Thorac. Cardiovasc. Surg., 66, 894.
15.
CooperJ. D., TeasdaleS., NelemsJ. M., GlynnM. F. X., MacGregorD. C., DuffinJ., and ScottA. A. (1976): “Cardiorespiratory Failure Secondary to Peripheral Pulmonary Emboli. Survival Following a Combination of Prolonged Extracorporeal Membrane Oxygenator Support and Pulmonary Embolectomy”, J. Thorac. Cardiovasc. Surg., 71, 872.
16.
DearingJ. P., SimpsonH. W., and VaskoJ. S. (1969): “Plasma Protein Denaturation at the Blood Gas Interface in Extracorporeal Oxygenators”, J. Extracorporeal Technol., 1, 9.
17.
de LevalM. R., HillD. J., MielkeC. H., BramsonM. L., SmithC., and GerbodeF. (1972): “Platelet Kinetics During Extracorporeal Circulation”, Trans. Am. Soc. Artif. Intern. OrgansXVIII, 355.
18.
de LevalM. R., HillD. J., MielkeC. H., MacurM. F., and GerbodeF. (1975): “Blood Platelets and Extracorporeal Circulation—Kinetic Studies in Dogs on Cardiopulmonary Bypass”, J. Thorac. Cardiovasc. Surg., 69, 144.
19.
DobellA. R. C., MitriM., GalvaR., SarkozyE., and MurphyD. R. (1965): “Biological Evaluation of Blood After Prolonged Recirculation Through Film and Membrane Oxygenators”, Ann. Surg., 161, 617.
20.
DuffinJ., MartinB., and CooperJ. D. (1976): “Control, Monitor and Alarm System for Clinical Application of a Membrane Oxygenator”, Canad. Anaesth. Soc. J., 23, 143.
21.
DunbarR. W., PriceK. A., and CannarellaC. F. (1974): “Microaggregate Blood Filters: Effect on Filtration Time, Plasma Haemoglobin and Fresh Blood Platelet Counts”, Anesth. Analg., 53, 577.
22.
DuttonR. C., EdmundsL. H., HutchinsonJ. C., and RoeB. B. (1974): “Platelet Aggregate Emboli Produced in Patients During Cardiopulmonary Bypass with Membrane and Bubble Oxygenators and Blood Filters”, J. Thorac. Cardiovasc. Surg., 67, 258.
23.
FongS. W., BurnsN. E., WilliamsG., WoldanskiC., GazzanigaA., and BartlettR. H. (1974): “Coagulation Effects of Prolonged Extracorporeal Circulation”, Trans. Am. Soc. Artif. Intern. OrgansXX, 239.
GeelhoedG. W., AdkinsP., CorsoP. J., and JosephW. L. (1975): “Clinical Effects of Membrane Lung Support for Acute Respiratory Failure”, Ann. Thorac. Surg., 20, 177.
26.
GeelhoedG. W., CorsoP. H., and JosephW. L. (1974): “Membrane Lung Venoarterial Bypass in the Successful Management of Lethal Pulmonary Embolism in Primates”, Trans. Am. Soc. Artif. Intern. OrgansXX, 57.
27.
GervinA. S., McNeerJ. F., WolfeW. G., PuckettC. L., and SilverD. (1974): “Ultrapore Haemofiltration During Extracorporeal Circulation”, J. Thorac. Cardiovasc. Surg., 67, 237.
28.
GilleJ. P., and BagniewskiA. M. (1976): “Ten Years of Use of Extracorporeal Membrane Oxygenation (E.C.M.O.) in the Treatment of Acute Respiratory Insufficiency (A.R.I.)”, Trans. Am. Soc. Artif. Intern. OrgansXXII, 102.
29.
HansonE. L., DrinkerP. A., DonH. F., Van DevanterS. H., Bonnet-EymardJ., and MooreF. D. (1974): “Venoarterial Bypass with a Membrane Oxygenator: Successful Respiratory Support in a Woman Following Pulmonary Haemorrhage Secondary to Renal Failure”, Surgery, 75, 557.
30.
HattersleyP. (1966): “Activated Coagulation Time of Whole Blood”, J. Amer. Med. Ass., 196, 436.
31.
HeidenD., MielkeC. H., RodveinR., and HillJ. D. (1975): “Platelets, Haemostasis, and Thromboembolism During Treatment of Acute Respiratory Insufficiency with Extracorporeal Membrane Oxygenation. Experience with 28 Clinical Perfusions”, J. Thorac. Cardiovasc. Surg., 70, 644.
32.
HillJ. D., BramsonM. L., OsborneJ. J., and GerbodeF. (1971): “Observations and Management During Clinical Veno-venous Bypass for Respiratory Insufficiency”, Mechanical Devices for Cardiopulmonary Assistance Adv. Cardiol., 6, 133.
33.
HillJ. D., de LevalM. R., DontignyL., BramsonM. L., OsbornJ., and GerbodeF. (1971): “Clinical Prolonged Extracorporeal Circulation for Respiratory Insufficiency”, Transplant Proc.III, 1437.
34.
HillJ. D., de LevalM. R., FallatR. J., BramsonM. L., EberhartR., SchulteH., OsbornJ., BarberR., and GerbodeF. (1972): “Acute Respiratory Insufficiency-treatment with Prolonged Extracorporeal Oxygenation”, J. Thorac. Cardiovasc. Surg., 64, 551.
35.
HillD. J., de LevalM. R., MielkeC. H., BramsonM. L., and GerbodeF. (1972): “Clinical Prolonged Extracorporeal Circulation for Respiratory Insufficiency: Haematological Effects”, Trans. Am. Soc. Artif. Intern. OrgansXVIII, 546.
36.
HillJ. D., FallatR. J., and CohnK. (1971): “Clinical Cardiopulmonary Dynamics During Prolonged Extracorporeal Circulation for Acute Respiratory Failure”, Trans. Am. Soc. Artif. Intern. Organs.XVII, 355.
37.
HillJ. D., RatliffJ. L., FallatR. J., TuckerH. J., LamyM., DietrichH., and GerbodeF. (1974): “Prognostic Factors in the Treatment of Acute Respiratory Insufficiency with Long Term Extracorporeal Oxygenation”, J. Thorac. Cardiovasc. Surg., 68, 905.
38.
IonescuM. I., and WoolerG. H. (Editors) (1976): Current Techniques in Extracorporeal Circulation.Butterworths, London. Table 3: 1 page 84.
39.
HubertJ. L., FinderE., and Marc la ForceF. (1972): “Prevention of Oxygen Toxicity in the Lungs”, Chest, 62, 365.
40.
KanarekD., ZapolW., AhluwaliaB., QuistJ., HalesC., and LilandA. (1974): “Radionucleotide Imaging of the Circulatory Distribution of Membrane Lung Perfusion”, Trans. Am. Soc. Artif. Intern. Organs.XX, 262.
41.
KarlsonK. E., MurphyW. R., KakvanM., AnthonyP., CooperG. N., RichardsonP. D., and GallettiP. M. (1974): “Total Cardiopulmonary Bypass with a New Microporous Teflon Membrane Oxygenator”, Surgery, 76, 935.
42.
KayserK. L. (1974): “Blood-gas Interface Oxygenators Versus Membrane Oxygenators”, Ann. Thorac. Surg., 17, 459.
43.
KolobowT., StoolE. W., SacksK. L., and VurekG. G. (1975): “Acute Respiratory Failure. Survival Following 10 Days Support with a Membrane Lung”, J. Thorac. Cardiovasc. Surg., 69, 947.
44.
KolobowT., StoolE. W., WeathersbyP. K., PeirceJ., HayanoF. (1974): “Superior Blood Compatibility of Silicone Rubber Free of Silica Filler in the Membrane Lung”, Trans. Am. Soc. Artif. Intern. OrgansXX A, 269.
45.
KolobowT., and ZapolW. M. (1970): “A New Thin Walled Non-kinking Catheter for Peripheral Vascular Cannulation”, Surgery, 68, 625.
46.
KolobowT., ZapolW. M., and SigmanR. L., and PeirceJ. (1970): “Partial Cardiopulmonary Bypass Lasting up to Seven Days in Alert Lambs with Membrane Lung Blood Oxygenation”, J. Thorac. Cardiovasc. Surg., 60, 781.
47.
KumarA., PontoppidanH., and FalkeK. H. (1973): “Pulmonary Barotrauma During Mechanical Ventilation”, Crit. Care Med., 1, 181.
48.
LandeA. J., EdwardsL., BlochJ. H., CarlsonR. G., SubramanianV. A., AscheimR. S., ScheidtS., FillmoreS., KillipT., and LilleheiC. W. (1970): “Clinical Experience with Emergency Use of Prolonged Cardiopulmonary Bypass with a Membrane Pump-oxygenator”, Ann. Thorac. Surg., 10, 409.
49.
LeeW. H., and HairstonP. (1971): “Structural Effects in Blood Proteins at the Gas-blood Interface”, Fed. Proc., 30, 1615.
50.
LeeW. H., KrumhaarD., DerryC., SachsD., LawrenceS. H., ClowesG. H., and MaloneyJ. V. (1961): “Comparison of the Effects of Membrane and Non-membrane Oxygenators on the Biochemical and Biophysical Characteristics of Blood”, Surg. Forum, 12, 200.
51.
LefrakE. A., StevensP. M., NoonG. P., and De BakeyM. E. (1973): “Current Status of Prolonged Extracorporeal Membrane Oxygenation for Acute Respiratory Failure”, Chest, 63, 773.
52.
MarcusA. J. (1969): “Blood Platelets”, N. Engl. J. Med., 280, 1213.
53.
McEnanyM. T., ZapolW. M., SeebacherJ., SkoskiewiczM., SchneiderR. C., ErdmannA. J., SniderM. T., KanarekD. J., and PeckA. G. (1975): “Cannulation of the Proximal Aorta During Long Term Membrane Lung Perfusion”, J. Thorac. Cardiovasc. Surg., 70, 631.
54.
MartyA. T., PratherJ., MatloffJ. M., and SchaubleJ. (1973): “Oncotic Effects of Dilutional Bypass, Albumin, and Diuretics”, Arch. Surg., 107, 21.
55.
NashG., BlennerhassetJ. B., and PontoppidonH. (1967): “Pulmonary Lesions Associated with Oxygen Therapy and Artificial Ventilation”, N. Eng. J. Med., 276, 368.
56.
PeirceE. C. (1974): “Is the Blood Gas Interface of Clinical Importance”, Ann. Thorac. Surg., 17, 526.
57.
PeirceE. C. (1972): “The Role of the Artificial Lung in the Treatment of Respiratory Insufficiency: A Perspective”, Chest62: Supplement Part 2, 1075.
58.
PeirceE. C.II, ThebautA. L., KentB. B., KirklandJ. S., GoetterW. E., and WrightB. G. (1971): “Techniques of Extended Perfusion Using a Membrane Lung”, Ann. Thorac. Surg., 12, 451.
59.
RatliffJ., HillJ. D., FallatR., ParrotJ., and TuckerH. (1975): “Complication Associated with Membrane Lung Support by Veno-arterial Perfusion”, Ann. Thorac. Surg., 19, 537.
60.
ReaW. J., FberleJ. W., EckerR. R., WatsonJ., and SuggW. L. (1973): “Long Term Membrane Oxygenation in Respiratory Failure”, Ann. Thorac. Surg., 15, 170.
61.
SandersonJ. M., WrightG., and SimsF. W. (1972): “Brain Damage in Dogs Immediately Following Pulsatile and Non-pulsatile Blood Flows in Extracorporeal Circulation”, Thorax, 27, 275.
62.
SalzmannE. W. (1963): “Blood Platelets and Extracorporeal Circulation”, Transfusion, 3, 274.
63.
SilvaJ., HoeksemaH., and FeketyF. R. (1973): “Transient Defects in Phagocytic Functions During Cardiopulmonary Bypass”, J. Thorac. Cardiovasc. Surg., 67, 175.
64.
SolisR. T., KennedyP. S., BeallA. C., NoonG. P., and De BakeyM. E. (1975): “Cardiopulmonary Bypass—Microembolization and Platelet Aggregation”, Circulation, 52, 103.
65.
SubramanianV., LowmanJ. T., and GansH. (1968): “Effect of Extracorporeal Circulation on Reticulo-endothelial Function”, Arch. Surg., 97, 330.
66.
TamariY., AledortL., PuszkinE., DegnanT. J., WagnerN., KaplittM. J., and PeirceE. C. (1975): “Functional Changes in Platelets During Extracorporeal Circulation”, Ann. Thorac. Surg., 19, 639.
67.
VervloetA. F. C., EdwardsM. J., and EdwardsM. L. (1970): “Minimal Apparent Blood Damage in Lande-Edwards Membrane Oxygenator at Physiologic Gas Tensions”, J. Thorac. Cardiovasc. Surg., 60, 774.
68.
WebberC., and GarnettE. (1973): “The Relationship Between Colloid Osmotic Pressure and Plasma Proteins During and After Cardiopulmonary Bypass”, J. Thorac. Cardiovasc. Surg., 65, 234.
69.
WhiteJ. J., Gibbs AndrewsH., RisembergH., MazurD., and HallerJ. A. (1971): “Prolonged Respiratory Support in Newborn Infants with a Membrane Oxygenator”, Surgery, 70, 288.
70.
ZapolW. M., and KitzR. A. (1972): “Buying Time with Artificial Lungs”, N. Engl. J. Med., 286, 657.
71.
ZapolW., PontoppidanH., McCulloughN., SchmidtV., BlandJ., and KitzR. (1972): “Clinical Membrane Lung Support for Acute Respiratory Insufficiency”, Trans. Am. Soc. Artif. Intern OrgansXVIII, 553.
72.
ZapolW. M., QuistJ., PontoppidanH., LilandA., McEnanyT., and LayerM. B. (1975): “Extracorporeal Perfusion for Acute Respiratory Failure. Recent Experience with the Spiral Coil Membrane Lung”, J. Thorac Cardiovasc. Surg., 69, 439.
