Critical Care 2009, 13:R205

Mortality of severe acute respiratory distress syndrome in adults is still unacceptably high. Extracorporeal membrane oxygenation (ECMO) could represent an important treatment option, if complications were reduced by new technical developments.

Methods
Efficiency, side effects and outcome of treatment with a new miniaturized device for veno-venous extracorporeal gas transfer were analysed in 60 consecutive patients with life-threatening respiratory failure.

Results
A rapid increase of PaO2/FiO2 from 64 (48-86) mmHg to 120 (84-171) mmHg and a decrease of PaCO2 from 63 (50-80) mmHg to 33 (29-39) mmHg were observed after start of the extracorporeal support (p<0.001). Gas exchange capacity of the device averaged 155 (116-182) mL/min for oxygen and 210 (164-251) mL/min for carbon dioxide. Ventilatory parameters were reduced to a highly protective mode, allowing a fast reduction of tidal volume from 495 (401-570) mL to 336 (292-404) mL (p < 0.001) and of peak inspiratory pressure from 36 (32-40) cmH2O to 31 (28-35) cmH2O (p < 0.001). Transfusion requirements averaged 0.8 (0.4-1.8) units of red blood cells per day. 62% of patients were weaned from the extracorporeal system, and 45% survived to discharge.

Conclusions
Veno-venous extracorporeal membrane oxygenation with a new miniaturized device supports gas transfer effectively, allows for highly protective ventilation and is very reliable. Modern ECMO technology extends treatment opportunities in severe lung failure.