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Extracorporeal gas exchange

Pesenti, Antonio; Zanella, Alberto; Patroniti, Nicolò

Current Opinion in Critical Care: February 2009 - Volume 15 - Issue 1 - p 52–58
doi: 10.1097/MCC.0b013e3283220e1f
Respiratory system: Edited by John Marini

Purpose of review: We report on recent advances and achievements on the use of extracorporeal gas exchange for long-term application in the therapy of critically ill patients with various forms of respiratory failure.

Recent findings: The most important results regarding the use of extracorporeal gas exchange are expected from the Conventional Ventilatory Support vs. Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR) study, a randomized clinical trial assessing the effectiveness of extracorporeal lung assist in acute respiratory distress syndrome patients. Although not yet formally published, the results of this study, if confirmed, represent the first positive randomized clinical trial on adult extracorporeal membrane oxygenation application in acute respiratory distress syndrome patients. Other important results come from the clinical application of interventional lung assist, a pumpless arteriovenous extracorporeal technique, in different clinical conditions (acute respiratory distress syndrome, bridge to transplantation, asthma, and trauma). Among technical progress, of particular interest is the development of microfiber, microporous polymethylpentene membrane lungs, which offer low resistance to blood flow, high gas transfer capability, and high leak-proof performance.

Summary: Results of recent clinical trials, widespread use of clinical applications, and technical progress are leading to reevaluation and extension of extracorporeal gas exchange in critically ill patients with respiratory failure of various forms. Further developments may come from low invasive techniques with high efficiency of CO2 removal from low blood flow.

Department of Experimental Medicine, University of Milano-Bicocca, Ospedale San Gerardo Nuovo dei Tintori, Monza, Milan, Italy

Correspondence to Antonio Pesenti, MD, Full Professor of Anesthesia and Intensive Care, Department of Experimental Medicine, University of Milano-Bicocca, Ospedale San Gerardo Nuovo dei Tintori, via Cadore 48, 20048 Monza, Milan, Italy Tel: +39 039 2333291; Fax: +39 039 2332297; e-mail: antonio.pesenti@unimib.it

© 2009 Lippincott Williams & Wilkins, Inc.