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Extracorporeal Membrane Oxygenation

Yıl 2018, Cilt: 21 Sayı: 3, 236 - 244, 02.12.2018

Öz

Extracorporeal membrane oxygenation
(ECMO) is an advanced cardiopulmonary bypass machine used in cardiac surgery
and can be lifesaving in patients with severe but reversible respiratory
failure and/or or cardiac failure, refractory to conventional therapy. ECMO is
not a cure for the underlying disease, but it is used as temporary support and
offers time for the recovery of organs. Moreover, it can be used as a bridge to
a more permanent device or cardiac transplantation.


The ECMO circuit basically consists of a vascular
cannula, a pump, and an artificial lung (oxygenator). It can be set in to two
main configurations. Veno-venous (V-V) ECMO provides lung support, while
veno-arterial (V-A) ECMO provides both heart and lung supports. Initially, ECMO
was used in neonatal and pediatric populations to treat respiratory failure.
Over time, with the accumulation of experience and advances in technology, the
application of ECMO has been extended, and the number of adult patients
receiving this therapy has substantially increased. In this review, we sought
to summarize patient selection, indications, contraindications, complications,
technical aspects, and outcomes of ECMO.

Kaynakça

  • 1. Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 1954;37:171-85.
  • 2. Kirklin JW, Donald DE, Harshbarger HG, Hetzel PS, Patrick RT, Swan HJ, et al. Studies in extracorporeal circulation. I. Applicability of Gibbon-type pump-oxygenator to human intracardiac surgery: 40 cases. Ann Surg 1956;144:2-8.
  • 3. Gaffney AM, Wildhirt SM, Griffin MJ, Annich GM, Radomski MW. Extracorporeal life support. BMJ 2010;341:c5317.
  • 4. Hill JD, O’Brien TG, Murray JJ, Dontigny L, Bramson ML, Osborn JJ. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med 1972;286:629-34.
  • 5. Bartlett RH, Gazzaniga AB, Wetmore NE, Rucker R, Huxtable RF. Extracorporeal membrane oxygenation (ECMO) in the treatment of cardiac and respiratory failure in children. Trans Am Soc Artif Intern Organs 1980;26:578-81.
  • 6. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351-63.
  • 7. Skinner SC, Hirschl RB, Bartlett RH. Extracorporeal life support. Semin Pediatr Surg 2006;15:242-50.
  • 8. Baufreton C, Intrator L, Jansen PG, te Velthuis H, Le Besnerais P, Vonk A, et al. Inflammatory response to cardiopulmonary bypass using roller or centrifugal pumps. Ann Thorac Surg 1999;67:972-7.
  • 9. Thiara AP, Hoel TN, Kristiansen F, Karlsen HM, Fiane AE, Svennevig JL. Evaluation of oxygenators and centrifugal pumps for long-term pediatric extracorporeal membrane oxygenation. Perfusion 2007;22:323-6.
  • 10. Peek GJ, Killer HM, Reeves R, Sosnowski AW, Firmin RK. Firman Early experience with a polymethyl pentene oxygenator for adult extracorporeal life support. ASAIO J 2002;48:480-2.
  • 11. Marasco SF, Lukas G, McDonald M, McMillan J, Ihle B. Review of ECMO (extra corporeal membrane oxygenation) support in critically ill adult patients. Heart Lung Circ 2008;17(Suppl 4):S41-7.
  • 12. Rich PB, Awad SS, Crotti S, Hirschl RB, Bartlett RH, Schreiner RJ. A prospective comparison of atrio-femoral and femoro-atrial flow in adult venovenouextracorporeal life support. J Thorac Cardiovasc Surg 1998;116:628-32.
  • 13. Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 2009;302:1888-95.
  • 14. Lequier L. Extracorporeal life support in pediatric and neonatal critical care: a review. J Intensive Care Med 2004;19:243-58.
  • 15. Sidebotham D, McGeorge A, McGuinness S, Edwards M, Willcox T, Beca J. Extracorporeal membrane oxygenation for treating severe cardiac and respiratory failure in adults: part 2-technical considerations. J Cardiothorac Vasc Anesth 2010;24:164-72.
  • 16. Fiser SM, Tribble CG, Kaza AK, Long SM, Zacour RK, Kern JA, et al. When to discontinue extracorporeal membrane oxygenation for postcardiotomy support. Ann Thorac Surg 2001;71:210-4.
  • 17. Marasco SF, Esmore DS, Negri J, Rowland M, Newcomb A, Rosenfeldt FL, et al. Early institution of mechanical support improves outcomes in primary cardiac allograft failure. J Heart Lung Transplant 2005;24:2037-42.
  • 18. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al.The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 2012;38:1573-82.
  • 19. Mugford M, Elbourne D, Field D. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Data Syst Rev 2008;3:CD001340.
  • 20. Frenckner B, Radell P. Respiratory failure and extracorporeal membrane oxygenation. Sem Pediatr Surg 2008;171:34-41.
  • 21. Braune S, Sieweke A, Brettner F, Staudinger T, Joannidis M. The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case-control study. Intensive Care Med 2016;429:1437-44.
  • 22. Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engström AE. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 2016;42:1922.
  • 23. Gaffney AM, Wildhirt SM, Griffin MJ, Annich GM, Radomski MW. Extracorporeal life support. BMJ 2010;341:5317.
  • 24. Marasco SF, Preovolos A, Lim K, Salamonsen RF. Thoracotomy in adults while on ECMO is associated with uncontrollable bleeding. Perfusion 2007;22:23-6.
  • 25. Plotz FB, Van Oeveren W, Bartlett RH, Wildevuur CR. Blood activation during neonatal extracorporeal life support. J Thorac Cardiovasc Surg 1993;105:823-32.
  • 26. Stallion A, Cofer B, Rafferty JA, Qiegler MM, Ryckman FC. The significant relationship between platelet count and haemorrhagic complications on ECMO. Perfusion 1994;9:265-9.
  • 27. Nuttall GA, Oliver WC, Santrach PJ, Bryant S, Dearani JA, Schaff HV, et al. Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology 2001;945:773-81.
  • 28. Conrad SA, Rycus PT, Dalton H. Extracorporeal life support registry report 2004. ASAIO J 2005;511:4-10.
  • 29. Braun JP, Schroeder T, Buehner S, Dohmen P, Moshirzadeh M, Grosse J, et al. Splanchnic oxygen transport, hepatic function and gastrointestinal barrier after normothermic cardiopulmonary bypass. Acta Anaesthesiol Scand 2004;48:697-703.
  • 30. Gander JW, Fisher JC, Reichstein AR, Gross ER, Aspelund G, Middlesworth W, et al. Limb ischemia after common femoral artery cannulation for venoarterial extracorporeal membrane oxygenation: an unresolved problem. J Pediatr Surg 2010;4511:2136-40.
  • 31. Xie A, Lo P, Yan TD, Forrest P. Neurologic complications of extracorporeal membrane oxygenation: a review. J Cardiothorac Vasc Anesth 2017;31:1836-46.
  • 32. Bartlett RH. Extracorporeal life support registry report 1995. ASAIO J 1997;43:104-7.
  • 33. MacLaren G, Pellegrino V, Butt W, Preovolos A, Salamonsen R. Successful use of ECMO in adults with life-threatening infections. Anaesth Intensive Care 2004;32:707-10.
  • 34. Hansell, DR. Extracorporeal membrane oxygenation for perinatal and pediatric patients. Respir Care 2003;48:352-62.
  • 35. Gray BW, Haft JW, Hirsch JC, Annich GM, Hirschl RB, Bartlett RH. Extracorporeal life support: experience with 2,000 patients. ASAIO J 2015;61:2-7.
  • 36. Aubron C, Cheng AC, Pilcher D, Leong T, Magrin G, Cooper DJ, et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care 2013;17:73.
  • 37. Shin TG, Choi JH, Jo IJ, Sim MS, Song HG, Jeong YK, et al. Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: a comparison with conventional cardiopulmonary resuscitation. Crit Care Med 2011;39:1-7.
  • 38. Sakamoto T, Morimura N, Nagao K, Asai Y, Yokota H, Nara S, et al. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study. Resuscitation 2014;85:762-8.
  • 39. Stub D, Bernard S, Pellegrino V, Smith K, Walker T, Sheldrake J, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial) Resuscitation 2015;86:88-94.
  • 40. Barbaro RP, Bartlett RH, Chapman RL, Paden ML, Roberts LA, Gebremariam A, et al. Development and validation of the neonatal risk estimate score for children using extracorporeal respiratory support. J Pediatr 2016;173:56-61.
  • 41. Barbaro RP, Boonstra PS, Paden ML, Roberts LA, Annich GM, Bartlett RH, et al. Development and validation of the pediatric risk estimate score for children using extracorporeal respiratory support (Ped-RESCUERS). Intensive Care Med 2016;42:879-88.
  • 42. Maul TM, Kuch BA, Wearden PD. Development of risk indices for neonatal respiratory extracorporeal membrane oxygenation. ASAIO J 2016;62:584-90.
  • 43. Hopper AO, Pageau J, Job L, Heart J, Deming DD, Peverini RL. Extracorporeal membrane oxygenation for perioperative support in neonatal and pediatric cardiac transplantation. Artif Organs 1999;23:1006-9.
  • 44. Beckmann A, Benk C, Beyersdorf F, Haimerl G, Merkle F, Mestres C, et al. Position article for the use of extracorporeal life support in adult patients. Eur J Cardiothorac Surg 2011;40:676-80.

Ekstrakorporal Membran Oksijenizasyonu

Yıl 2018, Cilt: 21 Sayı: 3, 236 - 244, 02.12.2018

Öz

Ekstrakorporal
membran oksijenizasyonu (ECMO), kardiyak cerrahide kullanılan
kardiyopulmoner-baypas makinesinden geliştirilmiştir ve geleneksel tedaviye yanıt
vermeyen şiddetli ama geri dönüşlü respiratuvar ve/veya kardiyak yetmezlikte
yaşam kurtarıcı olabilmektedir.  ECMO
altta yatan hastalığı iyileştirmez ancak organların toparlanabilmesi veya kalıcı
bir cihaz yerleştirilmesi ya da transplantasyon yapılabilmesi için gereken
zamanı kazandıran geçici bir çözüm sağlar. ECMO devresi basitçe vasküler
kanüller, pompa ve yapay akciğerden (oksijenatör) oluşmaktadır. İki
konfigürasyonda yerleştirilebilir; venö-venöz (VV) ECMO sadece respiratuar
destek için  kullanılırken venö-arteriyel
(VA) ECMO hem kardiyak hem respiratuar destek için kullanılmaktadır. Başlangıçta
ECMO, yenidoğan veya pediatrik hasta gruplarının respiratuar yetmezliği
tedavisinde kullanılırken yıllar içinde teknolojik gelişmelere ve artan
tecrübeye paralel olarak kullanım sahası genişlemiş yetişkin hastalarda da
giderek artan sayıda kullanılmaya başlanmıştır. Buna bağlı olarak pek çok soru
ortaya çıkmaktadır; hangi hasta, ne zaman, nasıl, neden? Bu derlemede biz ECMO
için hasta seçimi, endikasyonlar, kontrendikasyonlar, komplikasyonlar ve
ECMO’nun teknik özellikleri ve sonuçlarına değinmeye çalıştık.

Kaynakça

  • 1. Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med 1954;37:171-85.
  • 2. Kirklin JW, Donald DE, Harshbarger HG, Hetzel PS, Patrick RT, Swan HJ, et al. Studies in extracorporeal circulation. I. Applicability of Gibbon-type pump-oxygenator to human intracardiac surgery: 40 cases. Ann Surg 1956;144:2-8.
  • 3. Gaffney AM, Wildhirt SM, Griffin MJ, Annich GM, Radomski MW. Extracorporeal life support. BMJ 2010;341:c5317.
  • 4. Hill JD, O’Brien TG, Murray JJ, Dontigny L, Bramson ML, Osborn JJ. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med 1972;286:629-34.
  • 5. Bartlett RH, Gazzaniga AB, Wetmore NE, Rucker R, Huxtable RF. Extracorporeal membrane oxygenation (ECMO) in the treatment of cardiac and respiratory failure in children. Trans Am Soc Artif Intern Organs 1980;26:578-81.
  • 6. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351-63.
  • 7. Skinner SC, Hirschl RB, Bartlett RH. Extracorporeal life support. Semin Pediatr Surg 2006;15:242-50.
  • 8. Baufreton C, Intrator L, Jansen PG, te Velthuis H, Le Besnerais P, Vonk A, et al. Inflammatory response to cardiopulmonary bypass using roller or centrifugal pumps. Ann Thorac Surg 1999;67:972-7.
  • 9. Thiara AP, Hoel TN, Kristiansen F, Karlsen HM, Fiane AE, Svennevig JL. Evaluation of oxygenators and centrifugal pumps for long-term pediatric extracorporeal membrane oxygenation. Perfusion 2007;22:323-6.
  • 10. Peek GJ, Killer HM, Reeves R, Sosnowski AW, Firmin RK. Firman Early experience with a polymethyl pentene oxygenator for adult extracorporeal life support. ASAIO J 2002;48:480-2.
  • 11. Marasco SF, Lukas G, McDonald M, McMillan J, Ihle B. Review of ECMO (extra corporeal membrane oxygenation) support in critically ill adult patients. Heart Lung Circ 2008;17(Suppl 4):S41-7.
  • 12. Rich PB, Awad SS, Crotti S, Hirschl RB, Bartlett RH, Schreiner RJ. A prospective comparison of atrio-femoral and femoro-atrial flow in adult venovenouextracorporeal life support. J Thorac Cardiovasc Surg 1998;116:628-32.
  • 13. Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 2009;302:1888-95.
  • 14. Lequier L. Extracorporeal life support in pediatric and neonatal critical care: a review. J Intensive Care Med 2004;19:243-58.
  • 15. Sidebotham D, McGeorge A, McGuinness S, Edwards M, Willcox T, Beca J. Extracorporeal membrane oxygenation for treating severe cardiac and respiratory failure in adults: part 2-technical considerations. J Cardiothorac Vasc Anesth 2010;24:164-72.
  • 16. Fiser SM, Tribble CG, Kaza AK, Long SM, Zacour RK, Kern JA, et al. When to discontinue extracorporeal membrane oxygenation for postcardiotomy support. Ann Thorac Surg 2001;71:210-4.
  • 17. Marasco SF, Esmore DS, Negri J, Rowland M, Newcomb A, Rosenfeldt FL, et al. Early institution of mechanical support improves outcomes in primary cardiac allograft failure. J Heart Lung Transplant 2005;24:2037-42.
  • 18. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al.The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 2012;38:1573-82.
  • 19. Mugford M, Elbourne D, Field D. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Data Syst Rev 2008;3:CD001340.
  • 20. Frenckner B, Radell P. Respiratory failure and extracorporeal membrane oxygenation. Sem Pediatr Surg 2008;171:34-41.
  • 21. Braune S, Sieweke A, Brettner F, Staudinger T, Joannidis M. The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case-control study. Intensive Care Med 2016;429:1437-44.
  • 22. Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engström AE. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 2016;42:1922.
  • 23. Gaffney AM, Wildhirt SM, Griffin MJ, Annich GM, Radomski MW. Extracorporeal life support. BMJ 2010;341:5317.
  • 24. Marasco SF, Preovolos A, Lim K, Salamonsen RF. Thoracotomy in adults while on ECMO is associated with uncontrollable bleeding. Perfusion 2007;22:23-6.
  • 25. Plotz FB, Van Oeveren W, Bartlett RH, Wildevuur CR. Blood activation during neonatal extracorporeal life support. J Thorac Cardiovasc Surg 1993;105:823-32.
  • 26. Stallion A, Cofer B, Rafferty JA, Qiegler MM, Ryckman FC. The significant relationship between platelet count and haemorrhagic complications on ECMO. Perfusion 1994;9:265-9.
  • 27. Nuttall GA, Oliver WC, Santrach PJ, Bryant S, Dearani JA, Schaff HV, et al. Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology 2001;945:773-81.
  • 28. Conrad SA, Rycus PT, Dalton H. Extracorporeal life support registry report 2004. ASAIO J 2005;511:4-10.
  • 29. Braun JP, Schroeder T, Buehner S, Dohmen P, Moshirzadeh M, Grosse J, et al. Splanchnic oxygen transport, hepatic function and gastrointestinal barrier after normothermic cardiopulmonary bypass. Acta Anaesthesiol Scand 2004;48:697-703.
  • 30. Gander JW, Fisher JC, Reichstein AR, Gross ER, Aspelund G, Middlesworth W, et al. Limb ischemia after common femoral artery cannulation for venoarterial extracorporeal membrane oxygenation: an unresolved problem. J Pediatr Surg 2010;4511:2136-40.
  • 31. Xie A, Lo P, Yan TD, Forrest P. Neurologic complications of extracorporeal membrane oxygenation: a review. J Cardiothorac Vasc Anesth 2017;31:1836-46.
  • 32. Bartlett RH. Extracorporeal life support registry report 1995. ASAIO J 1997;43:104-7.
  • 33. MacLaren G, Pellegrino V, Butt W, Preovolos A, Salamonsen R. Successful use of ECMO in adults with life-threatening infections. Anaesth Intensive Care 2004;32:707-10.
  • 34. Hansell, DR. Extracorporeal membrane oxygenation for perinatal and pediatric patients. Respir Care 2003;48:352-62.
  • 35. Gray BW, Haft JW, Hirsch JC, Annich GM, Hirschl RB, Bartlett RH. Extracorporeal life support: experience with 2,000 patients. ASAIO J 2015;61:2-7.
  • 36. Aubron C, Cheng AC, Pilcher D, Leong T, Magrin G, Cooper DJ, et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care 2013;17:73.
  • 37. Shin TG, Choi JH, Jo IJ, Sim MS, Song HG, Jeong YK, et al. Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: a comparison with conventional cardiopulmonary resuscitation. Crit Care Med 2011;39:1-7.
  • 38. Sakamoto T, Morimura N, Nagao K, Asai Y, Yokota H, Nara S, et al. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study. Resuscitation 2014;85:762-8.
  • 39. Stub D, Bernard S, Pellegrino V, Smith K, Walker T, Sheldrake J, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial) Resuscitation 2015;86:88-94.
  • 40. Barbaro RP, Bartlett RH, Chapman RL, Paden ML, Roberts LA, Gebremariam A, et al. Development and validation of the neonatal risk estimate score for children using extracorporeal respiratory support. J Pediatr 2016;173:56-61.
  • 41. Barbaro RP, Boonstra PS, Paden ML, Roberts LA, Annich GM, Bartlett RH, et al. Development and validation of the pediatric risk estimate score for children using extracorporeal respiratory support (Ped-RESCUERS). Intensive Care Med 2016;42:879-88.
  • 42. Maul TM, Kuch BA, Wearden PD. Development of risk indices for neonatal respiratory extracorporeal membrane oxygenation. ASAIO J 2016;62:584-90.
  • 43. Hopper AO, Pageau J, Job L, Heart J, Deming DD, Peverini RL. Extracorporeal membrane oxygenation for perioperative support in neonatal and pediatric cardiac transplantation. Artif Organs 1999;23:1006-9.
  • 44. Beckmann A, Benk C, Beyersdorf F, Haimerl G, Merkle F, Mestres C, et al. Position article for the use of extracorporeal life support in adult patients. Eur J Cardiothorac Surg 2011;40:676-80.
Toplam 44 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Derleme
Yazarlar

Sadiye Deniz Özsoy Bu kişi benim

Hülya Yılmaz Ak Bu kişi benim

Yayımlanma Tarihi 2 Aralık 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 21 Sayı: 3

Kaynak Göster

Vancouver Özsoy SD, Yılmaz Ak H. Ekstrakorporal Membran Oksijenizasyonu. Koşuyolu Heart Journal. 2018;21(3):236-44.