Giuseppe
Emeritus
[Source: The Lancet Respiratory Medicine, full page: (LINK). Abstract, edited.]
The Lancet Respiratory Medicine, Early Online Publication, 17 October 2013, doi:10.1016/S2213-2600(13)70197-8
Copyright ? 2013 Elsevier Ltd All rights reserved.
Extracorporeal life support for adults with severe acute respiratory failure
Lorenzo Del Sorbo MD a c, Marcelo Cypel MD a b, Dr Eddy Fan MD a c
Summary
Extracorporeal life support (ECLS) is an artificial means of maintaining adequate oxygenation and carbon dioxide elimination to enable injured lungs to recover from underlying disease. Technological advances have made ECLS devices smaller, less invasive, and easier to use. ECLS might, therefore, represent an important step towards improved management and outcomes of patients with acute respiratory distress syndrome. Nevertheless, rigorous evidence of the ability of ECLS to improve short-term and long-term outcomes is needed before it can be widely implemented. Moreover, how to select patients and the timing and indications for ECLS in severe acute respiratory distress syndrome remain unclear. We describe the physiological principles, the putative risks and benefits, and the clinical evidence supporting the use of ECLS in patients with acute respiratory distress syndrome. Additionally, we discuss controversies and future directions, such as novel technologies and indications, mechanical ventilation of the native lung during ECLS, and ethics considerations.
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a Extracorporeal Life Support (ECLS) Program, University Health Network, Toronto, ON, Canada; b Department of Surgery, University of Toronto, Toronto, ON, Canada; c Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
Corresponding Author Information Correspondence to: Dr Eddy Fan, Critical Care Medicine, Toronto General Hospital, 585 University Avenue, 11C-1167, Toronto, ON, Canada M5G 2N2
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The Lancet Respiratory Medicine, Early Online Publication, 17 October 2013, doi:10.1016/S2213-2600(13)70197-8
Copyright ? 2013 Elsevier Ltd All rights reserved.
Extracorporeal life support for adults with severe acute respiratory failure
Lorenzo Del Sorbo MD a c, Marcelo Cypel MD a b, Dr Eddy Fan MD a c
Summary
Extracorporeal life support (ECLS) is an artificial means of maintaining adequate oxygenation and carbon dioxide elimination to enable injured lungs to recover from underlying disease. Technological advances have made ECLS devices smaller, less invasive, and easier to use. ECLS might, therefore, represent an important step towards improved management and outcomes of patients with acute respiratory distress syndrome. Nevertheless, rigorous evidence of the ability of ECLS to improve short-term and long-term outcomes is needed before it can be widely implemented. Moreover, how to select patients and the timing and indications for ECLS in severe acute respiratory distress syndrome remain unclear. We describe the physiological principles, the putative risks and benefits, and the clinical evidence supporting the use of ECLS in patients with acute respiratory distress syndrome. Additionally, we discuss controversies and future directions, such as novel technologies and indications, mechanical ventilation of the native lung during ECLS, and ethics considerations.
________
a Extracorporeal Life Support (ECLS) Program, University Health Network, Toronto, ON, Canada; b Department of Surgery, University of Toronto, Toronto, ON, Canada; c Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
Corresponding Author Information Correspondence to: Dr Eddy Fan, Critical Care Medicine, Toronto General Hospital, 585 University Avenue, 11C-1167, Toronto, ON, Canada M5G 2N2
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