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Clinical Pearls in Venovenous Extracorporeal Life Support for Adult Respiratory Failure

Tay, Chee Kiang MBBS*; Sung, Kiick MD; Cho, Yang Hyun MD

doi: 10.1097/MAT.0000000000000657
Review Article

Extracorporeal life support (ECLS) has been widely utilized to treat neonatal respiratory failure for two decades. However, its uptake in the case of adult respiratory failure has been slow because of a paucity of quality evidence and a sluggish tempo of ECLS-related technological advances. In recent years, interest in ECLS has been piqued after encouraging results were reported from its use during the 2009 H1N1 influenza pandemic. In a world constantly under threat from another influenza epidemic or deadly novel respiratory infection, e.g., the severe acute respiratory syndrome (SARS) virus, the Middle East respiratory syndrome coronavirus (MERS-CoV), the role of venovenous (VV) ECLS as a treatment modality for acute respiratory distress syndrome (ARDS) cannot be overemphasized. In hopes of standardizing practice, the Extracorporeal Life Support Organization (ELSO) has published books and guidelines on ECLS. However, high-level evidence to guide clinical decisions is still expediently needed in this field. Relying on the available literature and our experience in the recent South Korean MERS-CoV outbreak, we hope to highlight key physiologic and clinical points in VV ECLS for adult respiratory failure in this review.

From the *Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore; and Department of Thoracic & Cardiovascular Surgery, Samsung Medical Center, Seoul, South Korea.

Submitted for consideration April 2017; accepted for publication in revised form June 2017.

Disclosure: The authors have no conflicts of interest to report.

Correspondence: Yang Hyun Cho, MD, Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea. Email:

Copyright © 2018 by the American Society for Artificial Internal Organs