Artificial gas exchange membranes

The use of artificial membranes ex vivo to oxygenate and/or eliminate CO2 from blood is collectively known as extracorporeal gas exchange (T§ble..2). Long-term extracorporeal membrane oxygenation (ECMO) for acute espiratory failure was first used in the 1970s. It is labor intensive, involving continuous venoarterial bypass, and is often complicated by bleeding diatheses. Enthusiasm for ECMO evaporated in the 1980s after a multicenter prospective clinical trial in the United States demonstrated no benefit in survival. Extracorporeal CO2 removal (ECCO2R) is a similar technique, but involves low flow and venovenous support combined with low-frequency positive-pressure ventilation. CO 2 clearance is then independent of ventilatory attempts to increase oxygenation and the lungs can be 'rested'. The method is popular in mainland Europe, but the results of the only randomized controlled trial conducted to date have not been encouraging and suggest that ECCO 2R has no advantages over conventional pressure-controlled inverse ratio ventilation in terms of reduction in mortality ( Morris...et ai 1994).

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Table 2 Terms used in extracorporeal membrane oxygenation

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