Extracorporeal Life Support for Adults

276 Pages·2016·8.95 MB·English

by  Gregory A Schmidt (eds.)

Respiratory Medicine
Series Editor: Sharon I.S. Rounds
Gregory A. Schmidt Editor
Extracorporeal
Life Support for
Adults
Respiratory Medicine

Series Editor :
Sharon I.S. Rounds
More information about this series at h ttp://www.springer.com/series/7665

Gregory A. Schmidt
Editor
Extracorporeal Life Support
for Adults
Editor
Gregory A. Schmidt, MD
Division of Pulmonary Diseases, Critical Care,
and Occupational Medicine
Department of Internal Medicine
University of Iowa
Iowa City , IA , USA
ISSN 2197-7372 ISSN 2197-7380 (electronic)
Respiratory Medicine
ISBN 978-1-4939-3004-3 ISBN 978-1-4939-3005-0 (eBook)
DOI 10.1007/978-1-4939-3005-0
Library of Congress Control Number: 2015950466
Springer New York Heidelberg Dordrecht London
© Springer Science+Business Media New York 2016
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To William R. Lynch, MD, who built and
nurtured an outstanding program, exhibited
remarkable vision in how to advance ECLS
care, and opened my eyes to its new
possibilities.

Pref ace
Extracorporeal life support (ECLS) consists of using an external gas-exchanging
membrane to support oxygenation or carbon dioxide removal (or both), at times
including circulatory assistance. ECLS has been used in severe hypoxemic respira-
tory failure (ARDS, pneumonia); diseases dominated by ventilatory failure such as
status asthmaticus and COPD; cardiogenic shock; following cardiothoracic surgery
complicated by circulatory or gas exchange failure; and as a bridge to lung trans-
plant. Historically, ECLS has been used sparingly, often as a last resort, and in few
centers with the requisite expertise. Three factors have combined to change this.
First, technological improvements in membranes, pumps, circuits, and cannulas
have led to more effi cient and safer ECLS. Second, the CESAR trial has shown that,
for adults with severe ARDS, referral to an ECLS center improves outcomes.
Finally, the adverse consequences of conventional management of lung failure,
including ventilator-induced lung injury, ICU-acquired weakness, and nosocomial
infection, have become abundantly clear. Some of these may be ameliorated by
using ECLS in preference to conventional care. As perceptions of the role of ECLS
have evolved, more practitioners and more centers are developing ECLS capability
or positioning themselves to offer ECLS.
T he aim of this book is to deliver a concise, evidence-based review of ECLS for
adult disease. Adult medicine (rather than neonatal and pediatric disease, where
ECLS has an established but limited role) represents the growth area for
ECLS. Chapters are devoted to describing the complex physiology and technology;
the evidence base in varied clinical conditions; how to obtain vascular access; daily
management of the circuit and patient; guidance regarding the weaning and decan-
nulation process; and recommendations for crisis management and rehabilitation
related to ECLS. The text concludes with a fascinating historical review, showing
just how far we’ve come.
This text has been written for practicing physicians, nurses, perfusion specialists,
therapists, and critical care trainees who are considering whether to refer their
patients for ECLS, debating whether to offer ECLS capability to their patients, or
are already providing ECLS but seek a practical reference to best practices and
updated information. It could never have been completed without the inspiration
vii
viii Preface
from my colleagues at Iowa who strive daily to save the sickest patients; the trainees
whose curiosity makes us all want to know more; my contributors who are at the
forefront of a truly challenging fi eld; and our publisher at Springer-Link who pushed
for this important book. Finally, I recognize all those who do the hard work: the
nurses, perfusionists, and therapists who dedicate their lives to the critically ill. This
is an exciting time, ripe with change and opportunity. We seek a path forward for the
benefi t of all our patients.
Iowa City, IA, USA Gregory A. Schmidt, MD
Contents
1 Physiology of Extracorporeal Life Support (ECLS) ........................... 1
Matthew J . Brain , Warwick W. Butt , and Graeme MacLaren
2 Hypoxemic Respiratory Failure: Evidence, Indications,
and Exclusions ......................................................................................... 61
Darryl Abrams , Matthew Bacchetta , and Daniel Brodie
3 Cardiogenic Shock: Evidence, Indications, and Exclusions................ 73
Nicolas Bréchot and Alain Combes
4 ECCOR in Obstructive Diseases: Evidence, Indications,
2
and Exclusions ......................................................................................... 87
Lorenzo Del Sorbo and V. Marco Ranieri
5 ECLS as a Bridge to Lung Transplantation ......................................... 105
Christian Kuehn
6 Modes of ECLS ....................................................................................... 117
L. Keith Scott and Benjamin Schmidt
7 Vascular Access for ECLS ...................................................................... 133
Steven A. Conrad
8 Circuits, Membranes, and Pumps ......................................................... 147
Bradley H. Rosen
9 Ventilator Management During ECLS ................................................. 163
Antonio Pesenti , Giacomo Bellani , Giacomo Grasselli ,
and Tommaso Mauri
10 Daily Care on ECLS ............................................................................... 181
Giles J. Peek
11 Crises During ECLS ............................................................................... 193
Cara L. Agerstrand , Linda B. Mongero , Darryl Abrams ,
Matthew B acchetta , and Daniel Brodie
ix