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The ICM research agenda on extracorporeal life support

Alain Combes| Dan Brodie| Yih-Sharng Chen| Eddy Fan| José P. S. Henriques| Carol Hodgson| Philipp M. Lepper| Pascal Leprince| Kunihiko Maekawa| Thomas Muller| Sebastian Nuding| Dagmar M. Ouweneel| Antoine Roch| Matthieu Schmidt| Hiroo Takayama| Alain Vuylsteke| Karl Werdan| Laurent Papazian
Review
Volume 43, Issue 9 / September , 2017

Pages 1306 - 1318

Abstract

Purpose

This study aimed to concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to extracorporeal membrane oxygenation (ECMO).

Methods

Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion.

Results

The use of venovenous ECMO (VV-ECMO) is increasing in the most severe forms of acute lung injury. In patients with cardiogenic shock, short-term veno-arterial ECMO (VA-ECMO) provides both pulmonary and circulatory support. Technological improvements and recently published studies suggest that ECMO is able to improve patients’ outcomes. There are, however, many uncertainties regarding the real benefits of this technique both in hemodynamic and respiratory failure, the territorial organization to deliver ECMO, the indications and the use of concomitant treatments.

Conclusions

Although there have been considerable advances regarding the use of ECMO in critically ill patients, the risk/benefit ratio remains underinvestigated. ECMO indications, organization of ECMO delivery, and use of adjuvant therapeutics need also to be explored. Ongoing and future studies may be able to resolve these issues.

Keywords

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