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Research ArticleNew Horizons Symposium

Extracorporeal Membrane Oxygenation for ARDS: Optimization of Lung Protective Ventilation

Madhavi Parekh, Darryl Abrams, Daniel Brodie and Natalie H Yip
Respiratory Care September 2018, 63 (9) 1180-1188; DOI: https://doi.org/10.4187/respcare.06262
Madhavi Parekh
Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, New York.
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Darryl Abrams
Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, New York.
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Daniel Brodie
Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, New York.
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Natalie H Yip
Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, New York.
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    Fig. 1.

    Two-site approach to venovenous ECMO cannulation. The drainage cannula typically enters a femoral vein and extends into the inferior vena cava. Blood from the cannula is drawn into a pump. This blood is then propelled forward through the oxygenator before being reinfused into the body. The reinfusion cannula typically enters an internal jugular vein and extends into the right atrium, where blood is reinfused. From Reference 80, with permission.

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    Fig. 2.

    Single-site approach to venovenous ECMO cannulation. A dual-lumen cannula enters the internal jugular vein and terminates in the inferior vena cava. Blood enters the drainage lumen through ports in the inferior and superior vena cava and is drawn into the pump. This blood is then propelled forward through the oxygenator before being reinfused via the second lumen of the cannula, which has a port positioned in the right atrium and blood flow is directed across the tricuspid valve. From Reference 80, with permission.

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    Fig. 3.

    Venovenous-arterial ECMO cannulation. The venous drainage cannula enters a femoral vein and extends into the inferior vena cava. This blood is then drawn into a pump and propelled forward through the oxygenator before being reinfused into the body. The reinfusion of blood is split between a venous cannula, typically placed in an internal jugular vein, and an arterial cannula, typically placed in a femoral artery. From Reference 80, with permission.

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    Fig. 4.

    Management algorithm for patients with ARDS. Initial management for patients diagnosed with ARDS should include a low-volume, low-pressure ventilation strategy, with sedation and diuresis, as appropriate. Further interventions should be considered based on the severity of the ARDS. ECMO = extracorporeal membrane oxygenation. From Reference 81, with permission.

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Respiratory Care: 63 (9)
Respiratory Care
Vol. 63, Issue 9
1 Sep 2018
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Extracorporeal Membrane Oxygenation for ARDS: Optimization of Lung Protective Ventilation
Madhavi Parekh, Darryl Abrams, Daniel Brodie, Natalie H Yip
Respiratory Care Sep 2018, 63 (9) 1180-1188; DOI: 10.4187/respcare.06262

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Extracorporeal Membrane Oxygenation for ARDS: Optimization of Lung Protective Ventilation
Madhavi Parekh, Darryl Abrams, Daniel Brodie, Natalie H Yip
Respiratory Care Sep 2018, 63 (9) 1180-1188; DOI: 10.4187/respcare.06262
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  • Article
    • Abstract
    • Introduction
    • History of ECMO for ARDS
    • The ECMO Circuit and Configurations in ARDS
    • Ventilator Strategies With ECMO
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Keywords

  • ARDS
  • extracorporeal membrane oxygenation (ECMO)
  • respiratory failure
  • extracorporeal life support

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