The ICM research agenda on extracorporeal life support
Journal
Intensive Care Medicine
Journal Volume
43
Journal Issue
9
Pages
1306-1318
Date Issued
2017
Author(s)
Combes A.
Brodie D.
Fan E.
Henriques J.P.S.
Hodgson C.
Lepper P.M.
Leprince P.
Maekawa K.
Muller T.
Nuding S.
Ouweneel D.M.
Roch A.
Schmidt M.
Takayama H.
Vuylsteke A.
Werdan K.
Papazian L.
Abstract
Purpose: This study aimed to concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to extracorporeal membrane oxygenation (ECMO). Methods: Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion. Results: The use of venovenous ECMO (VV-ECMO) is increasing in the most severe forms of acute lung injury. In patients with cardiogenic shock, short-term veno-arterial ECMO (VA-ECMO) provides both pulmonary and circulatory support. Technological improvements and recently published studies suggest that ECMO is able to improve patients’ outcomes. There are, however, many uncertainties regarding the real benefits of this technique both in hemodynamic and respiratory failure, the territorial organization to deliver ECMO, the indications and the use of concomitant treatments. Conclusions: Although there have been considerable advances regarding the use of ECMO in critically ill patients, the risk/benefit ratio remains underinvestigated. ECMO indications, organization of ECMO delivery, and use of adjuvant therapeutics need also to be explored. Ongoing and future studies may be able to resolve these issues. ? 2017, Springer-Verlag Berlin Heidelberg and ESICM.
Subjects
Acute respiratory distress syndrome; Cardiogenic shock; Extracorporeal membrane oxygenation; Position article; Research agenda
SDGs
Other Subjects
acute lung injury; arteriovenous shunt; artificial ventilation; cardiogenic shock; clinical outcome; clinical research; diet therapy; extracorporeal membrane oxygenation device; extracorporeal oxygenation; human; intensive care; lung hemodynamics; lung transplantation; medical literature; pathophysiology; practice guideline; predictive value; respiratory failure; resuscitation; Review; risk benefit analysis; cardiogenic shock; critical illness; extracorporeal oxygenation; heart arrest; medical research; mortality; outcome assessment; procedures; prospective study; randomized controlled trial (topic); retrospective study; Acute Lung Injury; Biomedical Research; Critical Illness; Extracorporeal Membrane Oxygenation; Heart Arrest; Humans; Outcome Assessment (Health Care); Practice Guidelines as Topic; Prospective Studies; Randomized Controlled Trials as Topic; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies; Shock, Cardiogenic
Publisher
Springer Verlag
Type
review