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Return to ECMO Can Save Patients in Acute Respiratory Distress Overview

More on ECMO Can Save Patients in Acute Respiratory Distress

ECMO Can Save Patients in Acute Respiratory Distress

New York (Dec 1, 2011)

Drs. Daniel Brodie and Matthew Bacchetta
Drs. Daniel Brodie, left, and Matthew
Bacchetta are co-directors of the Center
for Acute Respiratory Failure.

Mechanical ventilation is the conventional device for treating patients with severe breathing difficulties. But the mechanical action of a ventilator may be too stressful for the delicate lungs of sick patients, whose lives may be in danger as their blood oxygen levels plummet. Today doctors have a lifesaving technology at their disposal called extracorporeal membrane oxygenation (ECMO).

ECMO acts as a temporary "artificial lung" for patients who are critically ill with lung failure. Similar to the heart-lung machines used during heart bypass surgery, ECMO works by pumping blood outside the body into a device that directly infuses oxygen and removes carbon dioxide before returning the blood to the patient. ECMO is sometimes used to treat severe acute respiratory distress syndrome (ARDS), and may also be used in selected patients with other forms of severe lung or heart failure.

An illustration of how ECMO works.
Click image to enlarge.

ARDS, which can be caused by injury or disease, affects more than 140,000 individuals a year in the United States. Death rates may be very high, especially in those with the most severe forms of the disease.

"The potential advantage of ECMO is that it seems to allow severely damaged lungs to rest so they can heal," said Daniel Brodie, M.D., who co-leads the ECMO program at the Center for Acute Respiratory Failure at NewYork-Presbyterian Hospital/Columbia University Medical Center with Matthew Bacchetta, M.D. "But early referral is key. The sooner we can help the patient in distress, the greater his or her chance of recovery." Drs. Brodie and Bacchetta published a review article in the November 17, 2011 issue of the New England Journal of Medicine, focusing on the advances made in the use of ECMO in adult patients with ARDS.

text from article

ECMO is not new. It's been in existence for 40 years. But its initial benefits were realized predominantly in infants and children. The evolution of ECMO technology led to improvements, and its expanded use in adults with ARDS during the H1N1 flu pandemic of 2009, as well as a large clinical trial that same year, suggested that it can indeed benefit adults in respiratory distress. These improvements include reducing the side effects that have been associated with the use of ECMO in adults in the past, and the development of a portable ECMO unit that can be used to transport critically ill patients to a center offering the technology. ECMO is available at very few hospitals. So when a patient at one hospital needs to be transferred to a medical center that offers ECMO, the benefit of the treatment needs to be weighed against the risk of the transport.

ECMO may be considered for patients in respiratory distress who need advanced therapy or expert consultation that is not available where they are. When the mobile ECMO transport team is deployed, the patient begins receiving ECMO in the first hospital and continues to receive it in the ambulance en route to the medical center that provides the technology. "ECMO makes it possible to bring many patients to our center who would traditionally be considered too unstable to be transferred between hospitals," said Dr. Brodie. "Evidence suggests that patients who are transferred to a center capable of doing ECMO in combination with advanced respiratory care do better overall.

"There are patients who are so critically ill that they need ECMO to stay alive," he continued. "There are clearly other patients who can benefit, but we are still learning who they are." Dr. Brodie added that clinical trials are under way to determine which patients would benefit most. Other studies are evaluating the use of ECMO to help patients with emphysema, sometimes known as chronic obstructive pulmonary disease, as well as other conditions.

Contributing faculty for this article:

Daniel Brodie, M.D., is the Co-Director of the Center for Acute Respiratory Failure at NewYork-Presbyterian and an Assistant Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons.

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