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Guidelines that describe the indications and practice of ECMO are published by the Extracorporeal Life Support Organization (ELSO). Criteria for the initiation of ECMO vary by institution, but generally include acute severe cardiac or pulmonary failure that is potentially reversible and unresponsive to conventional management.
The position of lung infiltrates in acute respiratory distress syndrome is non-uniform. Repositioning into the prone position (face down) might improve oxygenation by relieving atelectasis and improving perfusion. If this is done early in the treatment of severe ARDS, it confers a mortality benefit of 26% compared to supine ventilation.
The mortality is also similar to the 35% mortality seen in the EOLIA trial, the largest randomized controlled trial for ECMO in ARDS. [84] This registry based, multi-center, multi-country data provide provisional support for the use of ECMO for COVID-19 associated acute hypoxemic respiratory failure.
Additionally, Respiratory Therapists are commonly involved in ECMO management and many pursue certification in such therapies due to the intimate relationship of the heart and lungs. On-going critical care management of an ECMO patient commonly requires strict ventilator management in relation to the type of ECMO support used. [32]
BiPAP and CPAP can also be used as next level treatment. Finally, intubation with ventilator support can be used with positive pressure to improve ventilation and oxygenation. [9] In cases where methods to support the lungs to provide oxygen to the blood fail, extracorporeal membrane oxygenation, or ECMO can be considered.
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]
The European Consensus Guidelines on the Management of Respiratory Distress Syndrome highlight new possibilities for early detection, and therefore treatment of IRDS. [8] The guidelines mention an easy to use rapid point-of-care predictive test that is now available [ 9 ] and how lung ultrasound, with appropriate training, expertise and ...
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."
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