Università di Torino, Dipartimento di Anestesiologia e Medicina degli Stati Critici Ospedale S. Giovanni Battista-Molinette, Torino, Italy.
Curr Opin Crit Care. 2014 Feb;20(1):86-91. doi: 10.1097/MCC.0000000000000053.
To examine the role of extracorporeal membrane oxygenation (ECMO) as potential therapeutic option for severe cases of acute respiratory distress syndrome (ARDS).
The use of ECMO to treat acute respiratory failure dramatically increased. Factors that may explain this increase in the use of ECMO are H1N1 pandemic influenza, results of recent clinical trials and not lastly the technological development and consequently the commercial pressure of the industry. Under these circumstances, clinicians urgently need clinical trials and formal indication, contraindication and rules for implementation to provide reproducible results.
Guidelines from the Extracorporeal Life Support Organization still indicate ECMO for acute severe pulmonary failure potentially reversible and unresponsive to conventional management. The new definition of ARDS (Berlin definition) addresses clinicians to the best treatment options in respect of the severity of illness and allocates ECMO as a potential therapeutic option for patients with severe ARDS and a P/F ratio lower than 100 and proposed that the indication of ECMO may be shifted from the treatment of choice for refractory hypoxemia to the treatment of choice to minimize ventilator-induced lung injury.
探讨体外膜肺氧合（ECMO）在严重急性呼吸窘迫综合征（ARDS）中的治疗作用。
ECMO 治疗急性呼吸衰竭的应用显著增加。可能导致 ECMO 应用增加的因素有：甲型 H1N1 流感、最近临床试验的结果，以及技术的发展和产业的商业压力。在这种情况下，临床医生迫切需要临床试验和正式的适应证、禁忌证和实施规则，以提供可重复的结果。
体外生命支持组织的指南仍然表明 ECMO 适用于潜在可逆且对常规治疗无反应的急性严重肺衰竭。ARDS 的新定义（柏林定义）针对疾病严重程度向临床医生提供最佳治疗选择，并将 ECMO 作为严重 ARDS 患者和 PaO2/FiO2 比值低于 100 的患者的潜在治疗选择之一，并提出 ECMO 的适应证可能从难治性低氧血症的治疗选择转变为减轻呼吸机相关性肺损伤的治疗选择。
