Current Status of Prolonged Extracorporeal Membrane Oxygenation for Acute Respiratory Failure

¹ Cor and Webb Mading Department of Surgery and the Department of Medicine, Baylor College of Medicine, Houston, Texas
² Professor and Chairman, Department of Surgery

Membrane oxygenators, in which the traumatic direct blood-gas interface has been eliminated, have markedly increased the time that extracorporeal circulation can be safely maintained. The purpose of this presentation is to discuss the stage of development of current membrane lungs and to critically analyze the role of these devices in an organized approach to patients with acute respiratory failure. A guideline to the indications for instituting membrane oxygenator support is to consider the use of this adjunct to standard pulmonary care in all patients in whom the arterial Po₂ remains below 50 mm Hg despite continuous positive pressure ventilation with more than 50 percent oxygen. A review of the 41 reported cases in which extracorporeal membrane oxygenator assistance was utilized revealed that there is a degree of acute pulmonary damage which is not reversible no matter how long membrane oxygenation is maintained. In these situations, membrane lung support should be viewed as a temporizing measure to support life until lung replacement can be accomplished.