Page 106 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Masterclasses

M4.3 Extracorporeal Membrane Oxygenation Services 14:30 Convention Hall A

Tuesday, 3 May Use of Extracorporeal Membrane Oxygenation in Respiratory Failure
Yan WW
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong

Extracorporeal membrane oxygenation (ECMO) is a form of extracorporeal life support in which an external artificial circuit
carries venous blood from a patient to the oxygenator. The oxygenator is a gas exchange device where blood is enriched
with oxygen while carbon dioxide is removed. After this process, blood is returned to the patient’s circulation. When blood is
returned to the arterial system, it is a veno-arterial ECMO (VA-ECMO), which is a treatment for both cardiac and/or respiratory
failure. If blood is returned to the venous system, it is a veno-venous ECMO (VV-ECMO), which is a treatment for respiratory
failure only, not cardiac failure. There is also a variant form of low-flow VV-ECMO which is known as extracorporeal carbon
dioxide removal (ECCO2R). ECCO2R is effective in carbon dioxide removal but not oxygenation in patients with respiratory
failure.

VV-ECMO has regained its vitality since the release of UK-CESAR study in 2009. The CESAR study was an intention-to-treat
randomised controlled trial involving 180 adult patients with severe, but potentially reversible respiratory failure, defined as
a Murray score>3.0, or uncompensated hypercapnea with a pH<7.20. The result was positive. There was an absolute risk
reduction of 16% in its primary outcome of death or severe disability at six months after randomisation.

During the novel H1N1 human swine influenza pandemic, experience in many parts of the world suggested that ECMO was a
useful salvage therapy in the management of this viral infection with respiratory failure.

Besides pneumonia related respiratory failure, VV-ECMO should also be useful in other causes of respiratory failure that are
potentially reversible such as massive hemoptysis, status asthmaticus, acute respiratory distress syndrome (ARDS).

It is envisaged that in the near future, evidence supporting wider application of VV-ECMO and ECCO2R will be available. It
will become an important life-saving tool in the armamentarium of Intensive Care Unit.

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