Sadahiro Tomohito, Oda Shigeto, Nakamura Masataka, Hirayama Yo, Watanabe Eizo, Tateishi Yoshihisa, Shinozaki Koichiro
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba, 260-8677, Japan.
Gen Thorac Cardiovasc Surg. 2012 Apr;60(4):192-201. doi: 10.1007/s11748-011-0868-z. Epub 2012 Mar 28.
Various approaches such as ventilator management involving lung-protective ventilation, corticosteroids, prone positioning, and nitric oxide have failed to maintain sufficient lung oxygenation or appropriate ventilation competence in very severe acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) has been aggressively introduced for such patients, although in only a few institutions. The clinical usefulness of ECMO in a large-scale multicenter study (CESAR trial, 2009) and continued development/improvement of ECMO devices have facilitated performance of ECMO, with further increase in the number of institutions adopting ECMO therapy. Clinical usefulness of ECMO was documented in many cases of severe ARDS secondary to influenza A (H1N1) 2009 infection. ECMO requires establishment of an appropriate management system to minimize fatal complications (e.g., hemorrhage), which requires a multidisciplinary team. This, in combination with a new technique, interventional lung assist, will further extend the indications for ECMO. ECMO can be expected to gain importance as a respiratory support technique.
对于极重度急性呼吸窘迫综合征（ARDS）患者，诸如采用肺保护性通气的呼吸机管理、使用皮质类固醇、俯卧位通气以及一氧化氮等多种方法，均无法维持充足的肺氧合或适宜的通气能力。体外膜肺氧合（ECMO）已被积极应用于这类患者，不过仅在少数机构开展。在一项大规模多中心研究（2009年CESAR试验）中，ECMO的临床效用以及ECMO设备的持续研发改进，推动了ECMO的应用，采用ECMO治疗的机构数量也进一步增加。在许多2009年甲型H1N1流感感染继发的严重ARDS病例中，均证明了ECMO的临床效用。ECMO需要建立合适的管理系统，以将致命并发症（如出血）降至最低，而这需要一个多学科团队。这与一项新技术——介入性肺辅助相结合，将进一步扩大ECMO的适应证。作为一种呼吸支持技术，ECMO有望变得更加重要。
