Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: a comprehensive review

Kiran Shekar, Daniel V Mullany, Bruce Thomson, Marc Ziegenfuss, David G Platts, John F Fraser, Kiran Shekar, Daniel V Mullany, Bruce Thomson, Marc Ziegenfuss, David G Platts, John F Fraser

Abstract

Evolution of extracorporeal life support (ECLS) technology has added a new dimension to the intensive care management of acute cardiac and/or respiratory failure in adult patients who fail conventional treatment. ECLS also complements cardiac surgical and cardiology procedures, implantation of long-term mechanical cardiac assist devices, heart and lung transplantation and cardiopulmonary resuscitation. Available ECLS therapies provide a range of options to the multidisciplinary teams who are involved in the time-critical care of these complex patients. While venovenous extracorporeal membrane oxygenation (ECMO) can provide complete respiratory support, extracorporeal carbon dioxide removal facilitates protective lung ventilation and provides only partial respiratory support. Mechanical circulatory support with venoarterial (VA) ECMO employed in a traditional central/peripheral fashion or in a temporary ventricular assist device configuration may stabilise patients with decompensated cardiac failure who have evidence of end-organ dysfunction, allowing time for recovery, decision-making, and bridging to implantation of a long-term mechanical circulatory support device and occasionally heart transplantation. In highly selected patients with combined severe cardiac and respiratory failure, advanced ECLS can be provided with central VA ECMO, peripheral VA ECMO with timely transition to venovenous ECMO or VA-venous ECMO upon myocardial recovery to avoid upper body hypoxia or by addition of an oxygenator to the temporary ventricular assist device circuit. This article summarises the available ECLS options and provides insights into the principles and practice of these techniques. One should emphasise that, as is common with many emerging therapies, their optimal use is currently not backed by quality evidence. This deficiency needs to be addressed to ensure that the full potential of ECLS can be achieved.

Figures

Figure 1
Figure 1
Interventional lung assist device (iLA™; NovaLung GmbH, Talheim, Germany) for pumpless arterio-venous carbon dioxide removal. Reproduced with permission from [27].
Figure 2
Figure 2
Venoarterial extracorporeal membrane oxygenation. Venoarterial extracorporeal membrane oxygenation can be instituted: (a) centrally by cannulating the right atrium/inferior venacava and the aorta; (b) peripherally using the femoral vein and femoral artery (solid arrow, arterial return cannula; hollow arrow, back-flow cannula for distal limb perfusion); or (c) peripherally using the axillary/subclavian artery. The choice is often guided by the clinical setting, the expected duration of support and pulmonary function.
Figure 3
Figure 3
Biventricular assist device along with respiratory support provided by the oxygenator in the circuit. The hybrid Centrimag™ (Levitronix LLC, Waltham, MA, USA) extracorporeal membrane oxygenation system can be used as a biventricular assist device along with respiratory support provided by the oxygenator in the circuit. Reproduced with permission from [47]. LVAD, left ventricular assist device; RA, right atrium.
Figure 4
Figure 4
From venoarterial extracorporeal membrane oxygenation (ECMO) to use of ECMO as a temporary ventricular assist device. (A) Emergent femoro-femoral venoarterial extracorporeal membrane oxygenation. (B) Left ventricular apical cannulation and decompression. (C) Right ventricular recovery and isolated temporary left ventricular support. (D) Axillary artery cannulation to facilitate mobilisation. Reproduced with permission from [48].
Figure 5
Figure 5
Patient in extremis initially receiving femoro-femoral venoarterial extracorporeal membrane oxygenation (ECMO) with transition to venovenous ECMO. Patient in extremis initially received femoro-femoral venoarterial (VA) ECMO for severe cardiorespiratory failure with transition to venovenous (VV) ECMO on day 4 following satisfactory cardiac recovery. (a) Chest X-ray scan shows multistage access cannula in the right atrium (RA) during VA ECMO, (b) which was later withdrawn into the inferior vena cava (IVC) during VV ECMO. (b) A venous return cannula can also be seen in the right atrium.

References

    1. MacLaren G, Combes A, Bartlett RH. Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med. 2012;38:210–220. doi: 10.1007/s00134-011-2439-2.
    1. Bartlett RH, Gattinoni L. Current status of extracorporeal life support (ECMO) for cardiopulmonary failure. Minerva Anestesiol. 2010;76:534–540.
    1. Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, Forrest P, Gattas D, Granger E, Herkes R, Jackson A, McGuinness S, Nair P, Pellegrino V, Pettilä V, Plunkett B, Pye R, Torzillo P, Webb S, Wilson M, Ziegenfuss M. Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302:1888–1895.
    1. Fraser JF, Shekar K, Diab S, Dunster K, Foley SR, McDonald CI, Passmore M, Simonova G, Roberts JA, Platts DG, Mullany DV, Fung YL. ECMO – the clinician’s view. ISBT Sci Ser. 2012;7:82–88. doi: 10.1111/j.1751-2824.2012.01560.x.
    1. Lequier L, Horton SB, McMullan DM, Bartlett RH. Extracorporeal membrane oxygenation circuitry. Pediatr Crit Care Med. 2013;14((5 Suppl 1)):S7–S12.
    1. Allen S, Holena D, McCunn M, Kohl B, Sarani B. A review of the fundamental principles and evidence base in the use of extracorporeal membrane oxygenation (ECMO) in critically ill adult patients. J Intensive Care Med. 2011;26:13–26. doi: 10.1177/0885066610384061.
    1. Pipeling MR, Fan E. Therapies for refractory hypoxemia in acute respiratory distress syndrome. JAMA. 2010;304:2521–2527. doi: 10.1001/jama.2010.1752.
    1. Shekar K, Davies AR, Mullany DV, Tiruvoipati R, Fraser JF. To ventilate, oscillate, or cannulate? J Crit Care. 2013;28:655–662. doi: 10.1016/j.jcrc.2013.04.009.
    1. Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guérin C, Prat G, Morange S, Roch A. ACURASYS Study Investigators. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:1107–1116. doi: 10.1056/NEJMoa1005372.
    1. Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L. PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159–2168. doi: 10.1056/NEJMoa1214103.
    1. Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, Zhou Q, Matte A, Walter SD, Lamontagne F, Granton JT, Arabi YM, Arroliga AC, Stewart TE, Slutsky AS, Meade MO. OSCILLATE Trial Investigators; Canadian Critical Care Trials Group. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med. 2013;368:795–805. doi: 10.1056/NEJMoa1215554.
    1. Young D, Lamb S, Shah S, Mackenzie I, Tunnicliffe W, Lall R, Rowan K, Cuthbertson BH. OSCAR Study Group. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med. 2013;368:806–813. doi: 10.1056/NEJMoa1215716.
    1. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D. CESAR Trial Collaboration. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374:1351–1363. doi: 10.1016/S0140-6736(09)61069-2.
    1. Noah MA, Peek GJ, Finney SJ, Griffiths MJ, Harrison DA, Grieve R, Sadique MZ, Sekhon JS, McAuley DF, Firmin RK, Harvey C, Cordingley JJ, Price S, Vuylsteke A, Jenkins DP, Noble DW, Bloomfield R, Walsh TS, Perkins GD, Menon D, Taylor BL, Rowan KM. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1) JAMA. 2011;306:1659–1668. doi: 10.1001/jama.2011.1471.
    1. Pham T, Combes A, Roze H, Chevret S, Mercat A, Roch A, Mourvillier B, Ara-Somohano C, Bastien O, Zogheib E, Clavel M, Constan A, Marie Richard JC, Brun-Buisson C, Brochard L. REVA Research Network. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2013;187:276–285. doi: 10.1164/rccm.201205-0815OC.
    1. Patroniti N, Zangrillo A, Pappalardo F, Peris A, Cianchi G, Braschi A, Iotti GA, Arcadipane A, Panarello G, Ranieri VM, Terragni P, Antonelli M, Gattinoni L, Oleari F, Pesenti A. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med. 2011;37:1447–1457. doi: 10.1007/s00134-011-2301-6.
    1. Dominguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa-Perez L, de la Torre A, Poblano-Morales M, Baltazar-Torres JA, Bautista E, Martinez A, Martinez MA, Rivero E, Valdez R, Ruiz-Palacios G, Hernández M, Stewart TE, Fowler RA. Critically ill patients with 2009 influenza A(H1N1) in Mexico. JAMA. 2009;302:1880–1887. doi: 10.1001/jama.2009.1536.
    1. Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, Stelfox T, Bagshaw S, Choong K, Lamontagne F, Turgeon AF, Lapinsky S, Ahern SP, Smith O, Siddiqui F, Jouvet P, Khwaja K, McIntyre L, Menon K, Hutchison J, Hornstein D, Joffe A, Lauzier F, Singh J, Karachi T, Wiebe K, Olafson K, Ramsey C, Sharma S, Dodek P, Meade M, Hall R, Fowler RA. Canadian Critical Care Trials Group H1N1 Collaborative. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA. 2009;302:1872–1879. doi: 10.1001/jama.2009.1496.
    1. Forrest P, Ratchford J, Burns B, Herkes R, Jackson A, Plunkett B, Torzillo P, Nair P, Granger E, Wilson M, Pye R. Retrieval of critically ill adults using extracorporeal membrane oxygenation: an Australian experience. Intensive Care Med. 2011;37:824–830. doi: 10.1007/s00134-011-2158-8.
    1. Philipp A, Arlt M, Amann M, Lunz D, Muller T, Hilker M, Graf B, Schmid C. First experience with the ultra compact mobile extracorporeal membrane oxygenation system Cardiohelp in interhospital transport. Interact Cardiovasc Thorac Surg. 2011;12:978–981. doi: 10.1510/icvts.2010.264630.
    1. Cove ME, Maclaren G, Federspiel WJ, Kellum JA. Bench to bedside review: Extracorporeal carbon dioxide removal, past present and future. Crit Care. 2012;16:232. doi: 10.1186/cc11356.
    1. Bermudez CA, Rocha RV, Sappington PL, Toyoda Y, Murray HN, Boujoukos AJ. Initial experience with single cannulation for venovenous extracorporeal oxygenation in adults. Ann Thorac Surg. 2010;90:991–995. doi: 10.1016/j.athoracsur.2010.06.017.
    1. Terragni P, Birocco A, Ranieri VM. Extracorporeal lung support to remove carbon dioxide. Eur Respir Mon. 2012;55:142–152.
    1. Terragni PP, Del Sorbo L, Mascia L, Urbino R, Martin EL, Birocco A, Faggiano C, Quintel M, Gattinoni L, Ranieri VM. Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal. Anesthesiology. 2009;111:826–835. doi: 10.1097/ALN.0b013e3181b764d2.
    1. Bein T, Weber-Carstens S, Goldmann A, Muller T, Staudinger T, Brederlau J, Muellenbach R, Dembinski R, Graf BM, Wewalka M, Philipp A, Wernecke KD, Lubnow M, Slutsky AS. Lower tidal volume strategy (approximately 3 ml/kg) combined with extracorporeal CO2 removal versus ‘conventional’ protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study. Intensive Care Med. 2013;39:847–856. doi: 10.1007/s00134-012-2787-6.
    1. Wang D, Zhou X, Liu X, Sidor B, Lynch J, Zwischenberger JB. Wang-Zwische double lumen cannula – toward a percutaneous and ambulatory paracorporeal artificial lung. ASAIO J. 2008;54:606–611. doi: 10.1097/MAT.0b013e31818c69ab.
    1. Müller T, Lubnow M, Philipp A, Bein T, Jeron A, Luchner A, Rupprecht L, Reng M, Langgartner J, Wrede CE, Zimmermann M, Birnbaum D, Schmid C, Riegger GAJ, Pfeifer M. Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy. Eur Respir J. 2009;33:551–558. doi: 10.1183/09031936.00123608.
    1. Johnson P, Frohlich S, Westbrook A. Use of extracorporeal membrane lung assist device (Novalung) in H1N1 patients. J Card Surg. 2011;26:449–452. doi: 10.1111/j.1540-8191.2011.01261.x.
    1. Elliot SC, Paramasivam K, Oram J, Bodenham AR, Howell SJ, Mallick A. Pumpless extracorporeal carbon dioxide removal for life-threatening asthma. Crit Care Med. 2007;35:945–948. doi: 10.1097/01.CCM.0000257462.04514.15.
    1. Bartosik W, Egan JJ, Wood AE. The Novalung interventional lung assist as bridge to lung transplantation for self-ventilating patients – initial experience. Interact Cardiovasc Thorac Surg. 2011;13:198–200.
    1. Strueber M, Hoeper MM, Fischer S, Cypel M, Warnecke G, Gottlieb J, Pierre A, Welte T, Haverich A, Simon AR, Keshavjee S. Bridge to thoracic organ transplantation in patients with pulmonary arterial hypertension using a pumpless lung assist device. Am J Transplant. 2009;9:853–857. doi: 10.1111/j.1600-6143.2009.02549.x.
    1. Fischer S, Hoeper MM, Tomaszek S, Simon A, Gottlieb J, Welte T, Haverich A, Strueber M. Bridge to lung transplantation with the extracorporeal membrane ventilator Novalung in the veno-venous mode: the initial Hannover experience. ASAIO J. 2007;53:168–170. doi: 10.1097/MAT.0b013e31802deb46.
    1. Ruberto F, Pugliese F, D'Alio A, Perrella S, D'Auria B, Ianni S, Anile M, Venuta F, Coloni GF, Pietropaoli P. Extracorporeal removal CO2 using a venovenous, low-flow system (Decapsmart) in a lung transplanted patient: a case report. Transplant Proc. 2009;41:1412–1414. doi: 10.1016/j.transproceed.2009.03.048.
    1. Strueber M. Bridges to lung transplantation. Curr Opin Organ Transplant. 2011;16:458–461. doi: 10.1097/MOT.0b013e32834ac7ec.
    1. Strueber M. Extracorporeal support as a bridge to lung transplantation. Curr Opin Crit Care. 2010;16:69–73. doi: 10.1097/MCC.0b013e3283353ce0.
    1. Combes A, Leprince P, Luyt CE, Bonnet N, Trouillet JL, Leger P, Pavie A, Chastre J. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 2008;36:1404–1411. doi: 10.1097/CCM.0b013e31816f7cf7.
    1. ECLS Registry Report. Ann Arbor, MI: Extracorporeal Life Support Organisation; 2013. January.
    1. Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, Chen LC, Tsai PR, Wang SS, Hwang JJ, Lin FY. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008;372:554–561. doi: 10.1016/S0140-6736(08)60958-7.
    1. Thiagarajan RR. Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation: useful, but for whom? Crit Care Med. 2011;39:190–191. doi: 10.1097/CCM.0b013e318202e658.
    1. Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, Timothy Baldwin J, Young JB. Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. J Heart Lung Transplant. 2013;32:141–156. doi: 10.1016/j.healun.2012.12.004.
    1. Holman WL, Kormos RL, Naftel DC, Miller MA, Pagani FD, Blume E, Cleeton T, Koenig SC, Edwards L, Kirklin JK. Predictors of death and transplant in patients with a mechanical circulatory support device: a multi-institutional study. J Heart Lung Transplant. 2009;28:44–50. doi: 10.1016/j.healun.2008.10.011.
    1. Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, Morgan JA, Arabia F, Bauman ME, Buchholz HW, Deng M, Dickstein ML, El-Banayosy A, Elliot T, Goldstein DJ, Grady KL, Jones K, Hryniewicz K, John R, Kaan A, Kusne S, Loebe M, Massicotte MP, Moazami N, Mohacsi P, Mooney M, Nelson T, Pagani F, Perry W, Potapov EV. et al.The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32:157–187. doi: 10.1016/j.healun.2012.09.013.
    1. Combes A, Bacchetta M, Brodie D, Muller T, Pellegrino V. Extracorporeal membrane oxygenation for respiratory failure in adults. Curr Opin Crit Care. 2012;18:99–104. doi: 10.1097/MCC.0b013e32834ef412.
    1. Aiyagari RM, Rocchini AP, Remenapp RT, Graziano JN. Decompression of the left atrium during extracorporeal membrane oxygenation using a transseptal cannula incorporated into the circuit. Crit Care Med. 2006;34:2603–2606. doi: 10.1097/01.CCM.0000239113.02836.F1.
    1. Guirgis M, Kumar K, Menkis AH, Freed DH. Minimally invasive left-heart decompression during venoarterial extracorporeal membrane oxygenation: an alternative to a percutaneous approach. Interact Cardiovasc Thorac Surg. 2010;10:672–674.
    1. Vlasselaers D, Desmet M, Desmet L, Meyns B, Dens J. Ventricular unloading with a miniature axial flow pump in combination with extracorporeal membrane oxygenation. Intensive Care Med. 2006;32:329–333. doi: 10.1007/s00134-005-0016-2.
    1. Aggarwal A, Modi S, Kumar S, Korrapati C, Tatooles A, Pappas PS, Bhat G. Use of a single-circuit CentriMag® for biventricular support in postpartum cardiomyopathy. Perfusion. 2013;28:156–159. doi: 10.1177/0267659112464713.
    1. Massetti M, Gaudino M, Saplacan V, Farina P. From extracorporeal membrane oxygenation to ventricular assist device oxygenation without sternotomy. J Heart Lung Transplant. 2013;32:138–139. doi: 10.1016/j.healun.2012.10.003.
    1. Cove ME, MacLaren G. Clinical review: mechanical circulatory support for cardiogenic shock complicating acute myocardial infarction. Crit Care. 2010;14:235. doi: 10.1186/cc9229.
    1. Prutkin JM, Strote JA, Stout KK. Percutaneous right ventricular assist device as support for cardiogenic shock due to right ventricular infarction. J Invasive Cardiol. 2008;20:E215–E216.
    1. Rajagopal V, Steahr G, Wilmer CI, Raval NY. A novel percutaneous mechanical biventricular bridge to recovery in severe cardiac allograft rejection. J Heart Lung Transplant. 2010;29:93–95. doi: 10.1016/j.healun.2009.09.015.
    1. Gregory SD, Timms D, Gaddum N, Mason DG, Fraser JF. Biventricular assist devices: a technical review. Ann Biomed Eng. 2011;39:2313–2328. doi: 10.1007/s10439-011-0348-8.
    1. Skinner SC, Iocono JA, Ballard HO, Turner MD, Ward AN, Davenport DL, Paden ML, Zwischenberger JB. Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry. J Pediatr Surg. 2012;47:63–67. doi: 10.1016/j.jpedsurg.2011.10.018.
    1. Maclaren G, Butt W. Extracorporeal membrane oxygenation and sepsis. Crit Care Resusc. 2007;9:76–80.
    1. Brechot N, Luyt CE, Schmidt M, Leprince P, Trouillet JL, Leger P, Pavie A, Chastre J, Combes A. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013;41:1616–1626. doi: 10.1097/CCM.0b013e31828a2370.
    1. Firstenberg MS, Blais D, Abel E, Louis LB, Sun B, Mangino JE. Fulminant Neisseria meningitidis: role for extracorporeal membrane oxygenation. Heart Surg Forum. 2010;13:E376–E378. doi: 10.1532/HSF98.20101072.
    1. Navia JL, Atik FA, Beyer EA, Ruda Vega P. Extracorporeal membrane oxygenation with right axillary artery perfusion. Ann Thorac Surg. 2005;79:2163–2165. doi: 10.1016/j.athoracsur.2004.01.031.
    1. Moazami N, Moon MR, Lawton JS, Bailey M, Damiano R Jr. Axillary artery cannulation for extracorporeal membrane oxygenator support in adults: an approach to minimize complications. J Thorac Cardiovasc Surg. 2003;126:2097–2098. doi: 10.1016/S0022-5223(03)00965-6.
    1. Chamogeorgakis T, Lima B, Shafii AE, Nagpal D, Pokersnik JA, Navia JL, Mason D, Gonzalez-Stawinski GV. Outcomes of axillary artery side graft cannulation for extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2013;145:1088–1092. doi: 10.1016/j.jtcvs.2012.08.070.
    1. MacLaren G, Cove M, Kofidis T. Central extracorporeal membrane oxygenation for septic shock in an adult with H1N1 influenza. Ann Thorac Surg. 2010;90:e34–e35. doi: 10.1016/j.athoracsur.2010.06.019.
    1. MacLaren G, Butt W, Best D, Donath S. Central extracorporeal membrane oxygenation for refractory pediatric septic shock. Pediatr Crit Care Med. 2011;12:133–136. doi: 10.1097/PCC.0b013e3181e2a4a1.
    1. Shekar K, Fraser JF, Smith MT, Roberts JA. Pharmocokinetic changes in patients receiving extracorporeal membrane oxygenation. J Crit Care. 2012;27:741.e9–741.e18.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться