aMedical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris bSorbonne Pierre-Marie Curie University Paris, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France.
Curr Opin Crit Care. 2017 Feb;23(1):60-65. doi: 10.1097/MCC.0000000000000375.
This article summarizes the results of past and more recent series on venovenous extracorporeal membrane oxygenation (VV-ECMO) and discusses its potential indications beyond the rescue of patients with lung failure refractory to conventional mechanical ventilation.
Successful VV-ECMO treatment in patients with extremely severe influenza A(H1N1)-associated acute respiratory distress syndrome (ARDS) and positive results of the CESAR trial have led to an exponential use of the technology in recent years. Beyond its currently accepted indication as a salvage therapy in ARDS patients with refractory hypoxemia or unable to tolerate volume-limited strategies, VV-ECMO may improve the outcomes of less severe ARDS patients by facilitating lung-protective ventilation.
As initiation of VV-ECMO allows significant decrease in tidal volume, plateau and driving pressures, which has been associated with improved survival in ARDS patients, new trials should evaluate the impact of its early initiation in patients with severe but not refractory ARDS.
本文总结了过去和最近几批关于静脉-静脉体外膜肺氧合（VV-ECMO）的研究结果，并讨论了其在传统机械通气治疗无效的肺衰竭患者抢救以外的潜在适应证。
成功治疗严重甲型 H1N1 流感相关急性呼吸窘迫综合征（ARDS）患者的 VV-ECMO 治疗以及 CESAR 试验的阳性结果导致近年来该技术的应用呈指数级增长。除了目前作为 ARDS 患者难治性低氧血症或不能耐受容量限制策略的抢救治疗的适应证外，VV-ECMO 通过促进肺保护性通气，可能改善较轻 ARDS 患者的预后。
由于开始 VV-ECMO 可显著降低潮气量、平台压和驱动压，这与 ARDS 患者的生存率提高相关，因此新的试验应该评估在严重但非难治性 ARDS 患者中早期开始 VV-ECMO 的影响。
