Clinical experience

We initially selected patients according to the ECMO criteria which are based on oxygenation values in standardized ventilatory conditions. We later realized that a total static lung compliance above 30 ml/cmH2O was usually compatible with spontaneous breathing through a continuous positive airway pressure system. Patients with a total static lung compliance below 30 ml/cmH2O require a more invasive mode such as pressure-controlled inverse ratio ventilation or, if this technique is failing, LFPPV-ECCO2R. Therefore we added the further entry criterion of a total static lung compliance below 30 ml/cmH 2O measured at a tidal volume of 10 ml/kg under both anesthesia and paralysis. We have also recently added the criterion of a negative PEEP response; no patient undergoes extracorporeal support with a clinically important increase in oxygenation and a consistent clearing of CT scan densities when PEEP is increased from 5 to 15 cmH 2O.

Since 1979 we have treated 103 patients with LFPPV-ECCO2R with an overall survival rate of 42 per cent (CDFjgyrei). The most common indication for ECCO2R has been pneumonia, either viral or bacterial. This was the underlying etiology in 65 of our 98 ARDS patients. Nineteen had post-traumatic ARDS, and the reason for ECCO2R in the other 14 patients was thromboembolism, fat embolism, amniotic fluid pulmonary embolism, or septic shock. Three patients were treated with pulmonary lavage during extracorporeal support for alveolar proteinosis. Two patients were treated with partial extracorporeal support; one had decompensated chronic obstructive pulmonary disease, and the other was a patient with recurrent pneumothoraces secondary to congenital bullous emphysema.

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