Research progress of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in the treatment of adult severe respiratory failure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Fengxia , YAO Hao , REN Yun ,  LI Qingguo

Cardiovascular Center of The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, P.R.China;

Corresponding author：

LI Qingguo, Email: lqg0235062@163.com

Keywords：

Veno-venous extracorporeal membrane oxygenation (VV-ECMO); respiratory failure; acute respiratory distress syndrome (ARDS); review

DOI：

10.7507/1007-4848.202002085

Video：

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As an extracorporeal life support technology, veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been demonstrated its role in the treatment of patients with severe respiratory failure. Its main advantages include the ability to maintain adequate oxygenation and remove excess CO₂, increase oxygen delivery, improve tissue perfusion and metabolism, and implement lung protection strategies. Clinicians should accurately assess and identify the patient's condition, timely and accurately carry out VV-ECMO operation and management. This article will review the patient selection, cannulation strategy, anticoagulation, clinical management and weaning involved in the application of VV-ECMO.

Citation： LU Fengxia, YAO Hao, REN Yun, LI Qingguo. Research progress of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in the treatment of adult severe respiratory failure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1485-1490. doi: 10.7507/1007-4848.202002085 Copy

1.	Hill J, O'Brien TG, Murray JJ, et al. Prolonged extraco-rporeal oxygenator for acute post-traumatic respiratory failure. N Eng J Med, 1972: 286 (12): 629-634.
2.	Sauer CM, Yuh DD, Bonde P. Extracorporeal membrane oxygenation use has increased by 433% in adults in the United States from 2006 to 2011. ASAIO J, 2015, 61(1): 31-36.
3.	Fan E, Gattinoni L, Combes A, et al. Venovenous extracorporeal membrane oxygenation for acute respiratory failure: A clinical review from an international group of experts. Intensive Care Med, 2016, 42(5): 712-724.
4.	Ślusarz K, Kurdyś P, Armatowicz P, et al. Extracorporeal membrane oxygenation (ECMO) in the treatment of severe life-threatening respiratory failure. Wiad Lek, 2019, 72(92): 1822-1828.
5.	RozencwajgS, Pilcher D, Combes A, et al. Outcomes and survival prediction models for severe adult acute respiratory distress syndrome treated with extracorporeal membrane oxygenation. Critical Care, 2016, 20(1): 392.
6.	Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: A review. JAMA, 2019, 322(6): 557-568.
7.	Peek GJ, Mugford M, Tiruvoipati R, 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(9698): 1351-1363.
8.	中国医师协会体外生命支持专业委员会. 成人体外膜肺氧合循环辅助专家共识. 中华医学杂志, 2018, 98(12): 886-894.
9.	Rollins MD, Hubbard A, Zabrocki L, et al. Extracorporeal membrane oxygenation cannulation trends for pediatric respiratory failure and central nervous system injury. J Pediatr Surg, 2012, 47(1): 68-75.
10.	Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med, 2018, 378(21): 1965-1975.
11.	中国医师协会呼吸医师分会危重症医学专业委员会, 中华医学会呼吸病学分会危重症医学学组. 体外膜式氧合治疗成人重症呼吸衰竭推荐意见. 中华结核和呼吸杂志, 2019, 42(9): 660-684.
12.	Schmidt M, Bailey M, Sheldrake J, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J RespirCrit Care Med, 2014, 189(11): 1374-1382.
13.	Patel AR, Patel AR, Singh S, et al. Venovenous extracorporeal membrane oxygenation therapy in adults. Cureus, 2019, 11(8): 5365.
14.	Kuhl T, Michels G, Pfister R, et al. Comparison of the avalon dual-lumen cannula with conventional cannulation technique for venovenous extracorporeal membrane oxygenation. Thorac Cardiovasc Surg, 2015, 63(8): 653-662.
15.	JavidfarJ, Brodie D, Wang D, et al. Use of bicaval dual-lumen catheter for adult venovenous extracorporeal membrane oxygenation. Ann Thorac Surg, 2011, 91(6): 1763-1769.
16.	Hirose H, Yamane K, Marhefka G, et al. Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation. J Cardiothorac Surg, 2012, 7(1): 36.
17.	Bembea MM, Annich G, Rycus P, et al. Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: An international survey. Pediatric Critical Care Medicine, 2013, 14(2): 77.
18.	Grant AA, Hart VJ, Lineen EB, et al. A weaning protocol for venovenous extracorporeal membrane oxygenation with a review of the literature. Artificial Organs, 2018, 42(6): 605-610.
19.	Combs SE. A review of venovenous and venoarterial extracorporeal membrane oxygenation in neonates and children. Eur J Pediatr Surg, 2010, 20(1): 1-4.
20.	Brogan TV, Thiagarajan RR, Rycus PT, et al. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med, 2009, 35(12): 2105-2114.
21.	Biehl M, Kashiouris MG, Gajic O. Ventilator-induced lung injury: minimizing its impact in patients with or at risk for ARDS. Respiratory Care, 2013, 58(6): 927-937.
22.	Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness. JAMA, 2013, 310(15): 1591-1600.
23.	Kredel M, Bischof L, Wurmb T, et al. Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients. Perfusion, 2014, 29(2): 171-177.
24.	Bartlett RH. Physiology of gas exchange during ECMO for respiratory failure. J Intensive Care Med, 2017, 32(4): 243.
25.	Marhong JD, Munshi L, Detsky M, et al. Mechanical ventilation during extracorporeal life support (ECLS): a systematic review. Intensive Care Medicine, 2015, 41(6): 994-1003.
26.	Messai E, Bouguerra A, Guarracino F, et al. Low blood arterial oxygenation during venovenous extracorporeal membrane oxygenation: proposal for a rational algorithm-based management. J Intensive Care Med, 2016, 31(8): 553-560.
27.	Fletcher K, Chapman R, Keene S. An overview of medical ECMO for neonates. Semin Perinatol, 2018, 42(2): 68-79.
28.	Wu MY, Huang CC, Wu TI, et al. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome in adults: prognostic factors for outcomes. Medicine (Baltimore), 2016, 95(8): e2870.
29.	Stapel SN, de Grooth HJ, Alimohamad H, et al. Ventilator-derived carbon dioxide production to assess energy expenditure in critically ill patients: proof of concept. Crit Care, 2015, 19: 370.
30.	Velissaris D, Pierrakos C, Scolletta S, et al. High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients. Crit Care, 2011, 15(4): R177.
31.	De Backer D, Orbegozo Cortes D, Donadello K, et al. Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence, 2014, 5(1): 73-79.
32.	Donker DW, Brodie D, Henriques JPS, et al. Left ventricular unloading during veno-arterial ECMO: a review of percutaneous and surgical unloading interventions. Perfusion, 2019, 34(2): 98-105.
33.	Lorusso R, Raffa GM, Heuts S, et al. Pulmonary artery cannulation to enhance extracorporeal membrane oxygenation management in acute cardiac failure. Interact Cardiovasc Thorac Surg, 2020, 30(2): 215-222.
34.	Marhong JD, Telesnicki T, Munshi L, et al. Mechanical ventilation during extracorporeal membrane oxygenation. An international survey. Ann Am Thorac Soc, 2014, 11(6): 956-961.

1. Hill J, O'Brien TG, Murray JJ, et al. Prolonged extraco-rporeal oxygenator for acute post-traumatic respiratory failure. N Eng J Med, 1972: 286 (12): 629-634.
2. Sauer CM, Yuh DD, Bonde P. Extracorporeal membrane oxygenation use has increased by 433% in adults in the United States from 2006 to 2011. ASAIO J, 2015, 61(1): 31-36.
3. Fan E, Gattinoni L, Combes A, et al. Venovenous extracorporeal membrane oxygenation for acute respiratory failure: A clinical review from an international group of experts. Intensive Care Med, 2016, 42(5): 712-724.
4. Ślusarz K, Kurdyś P, Armatowicz P, et al. Extracorporeal membrane oxygenation (ECMO) in the treatment of severe life-threatening respiratory failure. Wiad Lek, 2019, 72(92): 1822-1828.
5. RozencwajgS, Pilcher D, Combes A, et al. Outcomes and survival prediction models for severe adult acute respiratory distress syndrome treated with extracorporeal membrane oxygenation. Critical Care, 2016, 20(1): 392.
6. Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: A review. JAMA, 2019, 322(6): 557-568.
7. Peek GJ, Mugford M, Tiruvoipati R, 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(9698): 1351-1363.
8. 中国医师协会体外生命支持专业委员会. 成人体外膜肺氧合循环辅助专家共识. 中华医学杂志, 2018, 98(12): 886-894.
9. Rollins MD, Hubbard A, Zabrocki L, et al. Extracorporeal membrane oxygenation cannulation trends for pediatric respiratory failure and central nervous system injury. J Pediatr Surg, 2012, 47(1): 68-75.
10. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med, 2018, 378(21): 1965-1975.
11. 中国医师协会呼吸医师分会危重症医学专业委员会, 中华医学会呼吸病学分会危重症医学学组. 体外膜式氧合治疗成人重症呼吸衰竭推荐意见. 中华结核和呼吸杂志, 2019, 42(9): 660-684.
12. Schmidt M, Bailey M, Sheldrake J, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J RespirCrit Care Med, 2014, 189(11): 1374-1382.
13. Patel AR, Patel AR, Singh S, et al. Venovenous extracorporeal membrane oxygenation therapy in adults. Cureus, 2019, 11(8): 5365.
14. Kuhl T, Michels G, Pfister R, et al. Comparison of the avalon dual-lumen cannula with conventional cannulation technique for venovenous extracorporeal membrane oxygenation. Thorac Cardiovasc Surg, 2015, 63(8): 653-662.
15. JavidfarJ, Brodie D, Wang D, et al. Use of bicaval dual-lumen catheter for adult venovenous extracorporeal membrane oxygenation. Ann Thorac Surg, 2011, 91(6): 1763-1769.
16. Hirose H, Yamane K, Marhefka G, et al. Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation. J Cardiothorac Surg, 2012, 7(1): 36.
17. Bembea MM, Annich G, Rycus P, et al. Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: An international survey. Pediatric Critical Care Medicine, 2013, 14(2): 77.
18. Grant AA, Hart VJ, Lineen EB, et al. A weaning protocol for venovenous extracorporeal membrane oxygenation with a review of the literature. Artificial Organs, 2018, 42(6): 605-610.
19. Combs SE. A review of venovenous and venoarterial extracorporeal membrane oxygenation in neonates and children. Eur J Pediatr Surg, 2010, 20(1): 1-4.
20. Brogan TV, Thiagarajan RR, Rycus PT, et al. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med, 2009, 35(12): 2105-2114.
21. Biehl M, Kashiouris MG, Gajic O. Ventilator-induced lung injury: minimizing its impact in patients with or at risk for ARDS. Respiratory Care, 2013, 58(6): 927-937.
22. Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness. JAMA, 2013, 310(15): 1591-1600.
23. Kredel M, Bischof L, Wurmb T, et al. Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients. Perfusion, 2014, 29(2): 171-177.
24. Bartlett RH. Physiology of gas exchange during ECMO for respiratory failure. J Intensive Care Med, 2017, 32(4): 243.
25. Marhong JD, Munshi L, Detsky M, et al. Mechanical ventilation during extracorporeal life support (ECLS): a systematic review. Intensive Care Medicine, 2015, 41(6): 994-1003.
26. Messai E, Bouguerra A, Guarracino F, et al. Low blood arterial oxygenation during venovenous extracorporeal membrane oxygenation: proposal for a rational algorithm-based management. J Intensive Care Med, 2016, 31(8): 553-560.
27. Fletcher K, Chapman R, Keene S. An overview of medical ECMO for neonates. Semin Perinatol, 2018, 42(2): 68-79.
28. Wu MY, Huang CC, Wu TI, et al. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome in adults: prognostic factors for outcomes. Medicine (Baltimore), 2016, 95(8): e2870.
29. Stapel SN, de Grooth HJ, Alimohamad H, et al. Ventilator-derived carbon dioxide production to assess energy expenditure in critically ill patients: proof of concept. Crit Care, 2015, 19: 370.
30. Velissaris D, Pierrakos C, Scolletta S, et al. High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients. Crit Care, 2011, 15(4): R177.
31. De Backer D, Orbegozo Cortes D, Donadello K, et al. Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence, 2014, 5(1): 73-79.
32. Donker DW, Brodie D, Henriques JPS, et al. Left ventricular unloading during veno-arterial ECMO: a review of percutaneous and surgical unloading interventions. Perfusion, 2019, 34(2): 98-105.
33. Lorusso R, Raffa GM, Heuts S, et al. Pulmonary artery cannulation to enhance extracorporeal membrane oxygenation management in acute cardiac failure. Interact Cardiovasc Thorac Surg, 2020, 30(2): 215-222.
34. Marhong JD, Telesnicki T, Munshi L, et al. Mechanical ventilation during extracorporeal membrane oxygenation. An international survey. Ann Am Thorac Soc, 2014, 11(6): 956-961.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Research progress of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in the treatment of adult severe respiratory failure

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