ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Review Case Reports
Extracorporeal membrane oxygenation in the management of diffuse alveolar hemorrhage.
Extracorporeal membrane oxygenation (ECMO) may be used to support patients with severe hypoxemic respiratory failure refractory to conventional mechanical ventilation. However, because systemic anticoagulation is generally required to maintain circuit patency, severe bleeding is often seen as a contraindication to ECMO. We describe our center's experience with four patients who received ECMO for refractory hypoxemic respiratory failure due to diffuse alveolar hemorrhage (DAH), a condition for which anticoagulation is typically contraindicated, and provide a review of the literature. ⋯ All four subjects (100%) survived to decannulation, and three subjects (75%) survived to discharge. The results from this case series, along with previously published data, suggest that ECMO is a reasonable management option for patients with DAH-associated severe, refractory hypoxemic respiratory failure. This is especially true in the era of modern ECMO technology where lower levels of anticoagulation are able to maintain circuit patency while minimizing bleeding risk.
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Recirculation, a phenomenon in which reinfused oxygenated blood is withdrawn by the drainage cannula without passing through the systemic circulation, decreases the efficiency with which venovenous extracorporeal membrane oxygenation (ECMO) provides oxygenation. The precise amount of recirculation may be difficult to quantify. ⋯ Several techniques, including the use of dual-lumen cannulae, have been successful in minimizing recirculation in venovenous ECMO. This article will provide an overview of the factors that affect recirculation, methods that may be used to quantify recirculation, and interventions that may reduce recirculation, thereby increasing ECMO efficiency.