Kopp R, Dembinski R, Kuhlen R
Department of Surgical Intensive Care Medicine University Hospital Aachen RWTH Aachen University, Aachen, Germany.
Minerva Anestesiol. 2006 Jun;72(6):587-95.
For patients with most severe acute respiratory distress syndrome (ARDS) conservative treatment with lung protective ventilation is often not sufficient to prevent life-threatening hypoxemia and additional strategies are necessary. Extracorporeal lung assist (ECLA) or extracorporeal membrane oxygenation (ECMO) using capillary membrane oxygenators can provide sufficient gas exchange and lung rest. In 2 randomized trials mortality was unchanged for ECMO. Today an technically enhanced ECMO is used for most severe ARDS using clinical algorithm and different case studies demonstrated a survival rate about 56%. Today miniaturized ECMO with optimized blood pumps and oxygenators are available and could enhance safety and clinical management. Another approach is an arterio-venous pumpless interventional lung assist (ILA) with a low resistance oxygenator. Advantages seem a simplified clinical management and less blood trauma. At present new devices are developed for chronic respiratory failure or bridge to lung transplant. Oxygenators with even less flow resistance could be implanted paracorporeal using the right ventricle as driving force. An intravascular oxygenator has been developed using the combination of a miniaturized blood pump and an oxygenator for implantation in the vena cava. Well designed clinical trials are necessary to demonstrate a clinical benefit for these experimental devices.
对于大多数重症急性呼吸窘迫综合征（ARDS）患者，采用肺保护性通气的保守治疗往往不足以预防危及生命的低氧血症，因此需要额外的治疗策略。使用毛细血管膜氧合器的体外肺辅助（ECLA）或体外膜肺氧合（ECMO）可以提供足够的气体交换并使肺得到休息。在两项随机试验中，ECMO治疗的患者死亡率未发生变化。如今，技术改进后的ECMO被用于治疗大多数重症ARDS患者，根据临床算法和不同的病例研究显示，其生存率约为56%。如今，具备优化血泵和氧合器的小型化ECMO已经问世，这可能会提高安全性并改善临床管理。另一种方法是采用低阻力氧合器的动静脉无泵介入式肺辅助（ILA）。其优点似乎是临床管理更简单，血液创伤更小。目前正在开发用于慢性呼吸衰竭或作为肺移植过渡手段的新设备。流动阻力更小的氧合器可以利用右心室作为驱动力进行体外植入。一种血管内氧合器已经研发出来，它将小型血泵和氧合器相结合，可植入腔静脉。需要精心设计的临床试验来证明这些实验性设备的临床益处。
