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Mortality at 60 days was the primary endpoint. The calculated sample size was 331 patients with an intent to show a 20% reduction in absolute mortality in the ECMO group. The main secondary endpoint was treatment failure – cross-over to ECMO due to refractory hypoxemia or death in the control group and death in the ECMO group.
Similarly as with adults ECMO is only indicated if reversal of the pathology for example with cardiac transplantation, is feasible. [27] When it comes to the consideration of the withdrawal of ECMO, unlike in adult populations parents are encouraged to make the final decision with guidance from the treating physicians.
There are two types of ECMO: Venovenous which provides respiratory support and venoarterial which provides respiratory and hemodynamic support. People with ARDS who do not require cardiac support typically undergo venovenous ECMO. Multiple studies have shown the effectiveness of ECMO in acute respiratory failure.
The pathophysiology of acute respiratory distress syndrome involves fluid accumulation in the lungs not explained by heart failure (noncardiogenic pulmonary edema). It is typically provoked by an acute injury to the lungs that results in flooding of the lungs' microscopic air sacs responsible for the exchange of gases such as oxygen and carbon dioxide with capillaries in the lungs. [1]
He held positions as Chief of General Surgery, program director of the Surgical Critical Care fellowship, and director of the extracorporeal life support laboratory and clinical service. He helped to start a breast care center affiliated with the university health system in 1984. [4] He established the Extracorporeal Life Support Organization ...
Intensive care medicine, usually called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. [1] It includes providing life support, invasive monitoring techniques, resuscitation, and end-of-life care. [2]
It has been revealed that patients with ARDS that show DAD on histology are at a high mortality rate of 71.9% compared to 45.5% in patients with ARDS but without DAD. [12] Of the patients who succumb to ARDS, the most common cause of death is septic shock with multi organ dysfunction syndrome.
The permissive hypercapnia leads to respiratory acidosis which might have negative side effects, but given that the patient is in ARDS, improving ventilatory function is more important. Since hypoxemia is a major life-threatening condition and hypercapnia is not, one might choose to accept the latter. Hence the term, "permissive hypercapnia."