Role of extracorporeal support

After 20 years of experience with extracorporeal support in adults, we have little doubt that ECCO 2R is a logical and rational form of therapy for severe ARDS. However, ECCO2R is not an ideal form of treatment since the technique carries a significant incidence of bleeding, which is a potentially lethal complication. However, the damage induced by mechanical ventilation in severe ARDS is well documented and justifies the search for alternative therapeutic strategies. Permissive hypercapnia is a treatment along these lines and may decrease the need for extracorporeal support. Currently, we still consider extracorporeal support to be an experimental technique for use in referral centers with sufficient motivation, technical skills, and personnel, where new technical solutions may be tested safely. This technique should only be proposed for widespread utilization when technical improvement and better biocompatibility of the components of the artificial lung assure the safety of long-term bypass.

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