Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: A comprehensive review

Shekar, Kiran, Mullany, Daniel V., Thomson, Bruce, Ziegenfuss, Marc, Platts, David G. and Fraser, John F. (2014) Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: A comprehensive review. Critical Care, 18 2: . doi:10.1186/cc13865

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Author Shekar, Kiran
Mullany, Daniel V.
Thomson, Bruce
Ziegenfuss, Marc
Platts, David G.
Fraser, John F.
Title Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: A comprehensive review
Journal name Critical Care   Check publisher's open access policy
ISSN 1364-8535
1466-609X
Publication date 2014-05-09
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/cc13865
Open Access Status DOI
Volume 18
Issue 2
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2015
Language eng
Abstract Evolution of extracorporeal life support (ECLS) technology has added a new dimension to the intensive care management of acute cardiac and/or respiratory failure in adult patients who fail conventional treatment. ECLS also complements cardiac surgical and cardiology procedures, implantation of long-term mechanical cardiac assist devices, heart and lung transplantation and cardiopulmonary resuscitation. Available ECLS therapies provide a range of options to the multidisciplinary teams who are involved in the time-critical care of these complex patients. While venovenous extracorporeal membrane oxygenation (ECMO) can provide complete respiratory support, extracorporeal carbon dioxide removal facilitates protective lung ventilation and provides only partial respiratory support. Mechanical circulatory support with venoarterial (VA) ECMO employed in a traditional central/peripheral fashion or in a temporary ventricular assist device configuration may stabilise patients with decompensated cardiac failure who have evidence of end-organ dysfunction, allowing time for recovery, decision-making, and bridging to implantation of a long-term mechanical circulatory support device and occasionally heart transplantation. In highly selected patients with combined severe cardiac and respiratory failure, advanced ECLS can be provided with central VA ECMO, peripheral VA ECMO with timely transition to venovenous ECMO or VA-venous ECMO upon myocardial recovery to avoid upper body hypoxia or by addition of an oxygenator to the temporary ventricular assist device circuit. This article summarises the available ECLS options and provides insights into the principles and practice of these techniques. One should emphasise that, as is common with many emerging therapies, their optimal use is currently not backed by quality evidence. This deficiency needs to be addressed to ensure that the full potential of ECLS can be achieved.
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Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2015 Collection
School of Medicine Publications
 
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