Agerstrand Cara L, Bacchetta Matthew D, Brodie Daniel
From the *Department of Medicine, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York; and †Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.
ASAIO J. 2014 May-Jun;60(3):255-62. doi: 10.1097/MAT.0000000000000062.
Extracorporeal membrane oxygenation (ECMO) is increasingly being used to support adults with severe forms of respiratory failure. Fueling the explosive growth is a combination of technological improvements and accumulating, although controversial, evidence. Current use of ECMO extends beyond its most familiar role in the support of patients with severe acute respiratory distress syndrome (ARDS) to treat patients with various forms of severe hypoxemic or hypercapnic respiratory failure, ranging from bridging patients to lung transplantation to managing pulmonary hypertensive crises. The role of ECMO used primarily for extracorporeal carbon dioxide removal (ECCO2R) in the support of patients with hypercapnic respiratory failure and less severe forms of ARDS is also evolving. Select patients with respiratory failure may be liberated from invasive mechanical ventilation altogether and some may undergo extensive physical therapy while receiving extracorporeal support. Current research may yield a true artificial lung with the potential to change the paradigm of treatment for adults with chronic respiratory failure.
体外膜肺氧合（ECMO）越来越多地用于支持患有严重呼吸衰竭的成年人。技术进步与越来越多（尽管存在争议）的证据相结合，推动了其迅猛发展。目前ECMO的应用范围已超越其最广为人知的在支持严重急性呼吸窘迫综合征（ARDS）患者方面的作用，扩展至治疗各种形式的严重低氧血症或高碳酸血症性呼吸衰竭患者，从为患者搭桥至肺移植到处理肺动脉高压危象。主要用于体外二氧化碳清除（ECCO2R）的ECMO在支持高碳酸血症性呼吸衰竭和不太严重形式的ARDS患者中的作用也在不断演变。部分呼吸衰竭患者可能完全摆脱有创机械通气，一些患者在接受体外支持时可能会接受广泛的物理治疗。当前的研究可能会产生一种真正的人工肺，有望改变成人慢性呼吸衰竭的治疗模式。
