Prolonged Duration ECMO for ARDS: Futility, Native Lung Recovery, or Transplantation?
Prolonged Duration ECMO for ARDS: Futility, Native Lung Recovery, or Transplantation?
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DOI：
10.1097/mat.0b013e3182a9e341
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发表时间：
2013-11-01
期刊：
影响因子：
4.2
通讯作者：
Napolitano, Lena M.
中科院分区：
文献类型：
--
作者：
Rosenberg, Andrew A.;Haft, Jonathan W.;Napolitano, Lena M.
根据柏林定义，建议将体外膜肺氧合（ECMO）作为严重急性呼吸窘迫综合征（PaO 2/FiO（2）100 mm Hg，呼气末正压5 cm H2O）的治疗方式。据报道，这些患者的ECMO持续时间通常为7 - 10天。然而，越来越多的报告显示，ECMO持续时间延长（> 14天）治疗呼吸衰竭的存活率为50 - 70%，自体肺恢复，并且ECMO桥接肺移植已在许多中心进行。目前，对于需要ECMO治疗急性呼吸衰竭的成人患者，何时考虑无效或肺移植尚无既定的国家标准。我们报告了一例长时间静脉-静脉ECMO（1，347小时，56.13天），自体肺恢复的病例，并讨论了优化ECMO患者自体肺恢复的治疗策略。在长时间的机械支持后，肺可能具有意外的再生能力，自体肺恢复，类似于急性肾损伤和自体肾恢复。我们建议重新定义ECMO中的不可逆肺损伤和无效性。
Extracorporeal membrane oxygenation (ECMO) is recommended as a treatment modality for severe acute respiratory distress syndrome (PaO2/FiO(2) 100 mm Hg with positive end-expiratory pressure 5 cm H2O) as defined by the Berlin definition. The reported usual duration of ECMO in these patients is 7-10 days. However, increasing reports of prolonged duration ECMO (>14 days) for respiratory failure document survival rates of 50-70% with native lung recovery, and ECMO bridge to lung transplantation has been performed at many centers. At present, there are no established national criteria for when to consider futility or lung transplantation in adult patients requiring ECMO for acute respiratory failure. We report a case of prolonged duration venovenous-ECMO (1,347 hours, 56.13 days), with native lung recovery and discuss treatment strategies to optimize native lung recovery in ECMO patients. The lung may have unexpected regenerative capacity with native lung recovery after prolonged mechanical support, similar to acute kidney injury and native renal recovery. We recommend redefining irreversible lung injury and futility in ECMO.