Download PDF
Semin Respir Crit Care Med 2006; 27(4): 416-425
DOI: 10.1055/s-2006-948295
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Acute Lung Injury and Acute Respiratory Distress Syndrome: Extracorporeal Life Support and Liquid Ventilation for Severe Acute Respiratory Distress Syndrome in Adults

J. Kristine Brown1 , Jonathan W. Haft1 , Robert H. Bartlett1 , Ronald B. Hirschl1
  • 1Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan
Further Information

Publication History

Publication Date:
14 August 2006 (online)

    Permissions and Reprints

ABSTRACT

Acute respiratory distress syndrome (ARDS) has many underlying causes and carries an overall mortality of 40 to 60%. For those patients with severe ARDS who have a predicted mortality of 80 to 100%, extracorporeal life support (ECLS) can provide an extraordinary means of support. We recently demonstrated a survival to hospital discharge of 52% in this subset of patients. ECLS is capable of providing full respiratory and cardiac support, allowing time for the patient to recover from the underlying disease process. Additionally, ventilator settings are reduced to “rest” settings, avoiding the consequences of ventilator-induced lung injury that can contribute to a worse outcome. Systemic heparinization is a mainstay of ECLS therapy because of platelet activation in the circuit. Mechanical complications and significant bleeding can occur in up to one quarter of patients, requiring close attention and prompt intervention should they occur. Although not currently in clinical practice, liquid ventilation using perfluorocarbons to provide gas exchange in the lungs is a potentially useful adjunct in the management of severe respiratory failure.

KEYWORDS

Extracorporeal life support - liquid ventilation - ARDS

REFERENCES

  • 1 Vasilyev S, Schaap R N, Mortensen J D. Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units: an international, multicenter, prospective survey.  Chest. 1995;  107 1083-1088
    CrossrefPubMedGoogle Scholar
  • 2 Luhr O R, Antonsen K, Karlsson M et al.. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland.  Am J Respir Crit Care Med. 1999;  159 1849-1861
    PubMedGoogle Scholar
  • 3 The Acute Respiratory Distress Syndrome Network . Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.  N Engl J Med. 2000;  342 1301-1308
    CrossrefPubMedGoogle Scholar
  • 4 Esteban A, Inmaculada A, Gordo F et al.. Prospective randomized trial comparing pressure-controlled ventilation and volume-controlled ventilation in ARDS.  Chest. 2000;  117 1690-1696
    CrossrefPubMedGoogle Scholar
  • 5 Bersten A D, Edibam C, Hunt T et al.. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states.  Am J Respir Crit Care Med. 2002;  165 443-448
    CrossrefPubMedGoogle Scholar
  • 6 Bartlett R H, Morris A H, Fairley H B et al.. A prospective study of acute hypoxic respiratory failure.  Chest. 1986;  89 684-689
    PubMedGoogle Scholar
  • 7 Kammermeyer K. Silicone rubber as a selective barrier.  Ind Eng Chem. 1957;  49 1685
    CrossrefPubMedGoogle Scholar
  • 8 Hill D, O'Brien T G, Murray J J et al.. Extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome): use of the Bramson membrane lung.  N Engl J Med. 1972;  286 629-634
    CrossrefPubMedGoogle Scholar
  • 9 Zapol W M, Snider M T, Hill J D et al.. Extracorporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective study.  JAMA. 1979;  242 2193-2196
    CrossrefPubMedGoogle Scholar
  • 10 Bartlett R H, Andrews A F, Toomasian J M et al.. Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure: 45 cases.  Surgery. 1982;  92 425-453
    PubMedGoogle Scholar
  • 11 Krummel T M, Greenfield L J, Kirkpatrick B V et al.. The early evaluation of survivors after extracorporeal membrane oxygenation for neonatal pulmonary failure.  J Pediatr Surg. 1984;  19 585-590
    PubMedGoogle Scholar
  • 12 Towne B H, Lott I T, Hicks D A et al.. Long-term follow-up of infants and children treated with extracorporeal membrane oxygenation (ECMO): a preliminary report.  J Pediatr Surg. 1985;  20 410-414
    PubMedGoogle Scholar
  • 13 Bartlett R H, Roloff D W, Custer J R et al.. Extracorporeal life support: the University of Michigan experience.  JAMA. 2000;  283 904-908
    CrossrefPubMedGoogle Scholar
  • 14 Swaniker F, Kolla S, Moler F et al.. Extracorporeal life support outcome for 128 pediatric patients with respiratory failure.  J Pediatr Surg. 2000;  35 197-202
    CrossrefPubMedGoogle Scholar
  • 15 Anderson H L, Delius R E, Sinard J M et al.. Early experience with extracorporeal membrane oxygenation in the modern era.  Ann Thorac Surg. 1992;  53 553-563
    PubMedGoogle Scholar
  • 16 Anderson H L, Steimle C, Shapiro M B et al.. Extracorporeal life support for adult cardiorespiratory failure.  Surgery. 1993;  114 161-173
    PubMedGoogle Scholar
  • 17 Shapiro M B, Kleaveland A C, Bartlett R H. Extracorporeal life support for status asthmaticus.  Chest. 1993;  103 1651-1654
    PubMedGoogle Scholar
  • 18 Anderson H L, Shapiro M B, Delius R E et al.. Extracorporeal life support for respiratory failure after multiple trauma.  J Trauma. 1994;  37 266-274
    PubMedGoogle Scholar
  • 19 Hemmila M R, Rowe S A, Boules T N et al.. Extracorporeal life support for severe acute respiratory distress syndrome in adults.  Ann Surg. 2004;  240 595-607
    PubMedGoogle Scholar
  • 20 Zwischenberger J B, Bartlett R H. An introduction to extracorporeal life support. In: Zwischenberger JB, Bartlett RH ECMO: Extracorporeal Cardiopulmonary Support in Critical Care. Ann Arbor; Extracorporeal Life Support Organization 1995: 11-13
    Google Scholar
  • 21 Hirschl R B. Devices. In: Zwischenberger JB, Bartlett RH ECMO: Extracorporeal Cardiopulmonary Support in Critical Care. Ann Arbor; Extracorporeal Life Support Organization 1995: 159-190
    Google Scholar
  • 22 Kolobow T, Bowman R L. Construction and evaluation of an alveolar membrane artificial heart lung.  ASAIO Trans. 1963;  9 238
    PubMedGoogle Scholar
  • 23 Bartlett R H. Physiology of extracorporeal life support. In: Zwischenberger JB, Bartlett RH ECMO: Extracorporeal Cardiopulmonary Support in Critical Care. Ann Arbor; Extracorporeal Life Support Organization 1995: 27-52
    Google Scholar
  • 24 Galleti P M, Richardson P D, Snider M T. A standardized method for defining the overall gas transfer performance of artificial lungs.  ASAIO Trans. 1972;  18 359
    PubMedGoogle Scholar
  • 25 Fauza D O, Hines M H, Wilson J M. ECMO: Hemodynamics, perfusion, and blood volume. In: Zwischenberger JB, Bartlett RH ECMO: Extracorporeal Cardiopulmonary Support in Critical Care. Ann Arbor; Extracorporeal Life Support Organization 1995: 74-79
    Google Scholar
  • 26 Cornish J D, Heiss K H, Clark R H et al.. Efficacy of venovenous extracorporeal membrane oxygenation for neonates with respiratory and circulatory compromise.  J Pediatr. 1993;  122 105-109
    PubMedGoogle Scholar
  • 27 Streiper M J, Sharma S, Dooley K J et al.. Effects of of venovenous extracorporeal membrane oxygenation on cardiac performance as determined by echocardiographic measurements.  J Pediatr. 1993;  122 950-955
    PubMedGoogle Scholar
  • 28 Dickson M E, Hirthler M A, Simoni J et al.. Stunned myocardium during extracorporeal membrane oxygenation.  Am J Surg. 1990;  160 644-646
    PubMedGoogle Scholar
  • 29 Secker-Walker J S, Edmonds J F, Spratt E H et al.. The source of coronary perfusion during partial bypass for extracorporeal membrane oxygenation (ECMO).  Ann Thorac Surg. 1976;  21 138-143
    PubMedGoogle Scholar
  • 30 Gertsmann D R, Nose K, Kinsella J P et al.. Left carotid artery and coronary arterial flow partitioning during neonatal ECMO [abstract].  Pediatr Res. 1989;  25 37A
    PubMedGoogle Scholar
  • 31 Rich P B, Younger J G, Soldes O S et al.. Use of extracorporeal life support for adult patients with respiratory failure and sepsis.  ASAIO J. 1998;  44 263-266
    PubMedGoogle Scholar
  • 32 Pagani F D, Aaronson K D, Swaniker F, Bartlett R H. The use of extracorporeal life support in adult patients with primary cardiac failure as a bridge to implantable left ventricular assist device.  Ann Thorac Surg. 2001;  71(Suppl 3) S77-S81
    CrossrefPubMedGoogle Scholar
  • 33 Pagani F D, Aaronson K D, Dyke D B, Wright S, Swaniker F, Bartlett R H. Assessment of an extracorporeal life support to LVAD bridge to heart transplant strategy.  Ann Thorac Surg. 2000;  70 1977-1984
    CrossrefPubMedGoogle Scholar
  • 34 Westfall S H, Stephens C, Kesler K et al.. Complement activation during prolonged extracorporeal membrane oxygenation.  Surgery. 1991;  110 887-891
    PubMedGoogle Scholar
  • 35 Hirthler M, Simoni J, Dickson M. Elevated levels of endotoxin, oxygen-derived free radicals, and cytokine during extracorporeal membrane oxygenation.  J Pediatr Surg. 1992;  27 1199-1202
    CrossrefPubMedGoogle Scholar
  • 36 Cleland J, Pluth J R, Tauxe W N et al.. Blood volume and body fluid compartment changes soon after closed and open intracardiac surgery.  J Thorac Cardiovasc Surg. 1966;  52 698-705
    PubMedGoogle Scholar
  • 37 Kazzi J K, Schwartz C A, Palder S B et al.. Effect of extracorporeal membrane oxygenation on body water content and distribution in lambs.  ASAIO Trans. 1990;  36 17-20
    PubMedGoogle Scholar
  • 38 Colman R W. Surface-mediated defense reactions: the plasma contact activation system.  J Clin Invest. 1984;  73 1249-1253
    CrossrefPubMedGoogle Scholar
  • 39 Lindon J N, McManama G, Kushner L et al.. Does the conformation of release adsorbed fibrinogen dictatew platelet interactions with artificial surfaces?.  Blood. 1986;  68 355-362
    PubMedGoogle Scholar
  • 40 Spannagl M, Dietrich W, Beck A et al.. High dose aprotinin reduces prothrombin and fibrinogen conversion in patients undergoing extracorporeal circulation for myocardial revascularization (letter).  Thromb Haemost. 1994;  72 159-160
    PubMedGoogle Scholar
  • 41 Wachtfogel Y T, Kucich U, Hack C E et al.. Aprotinin inhibits the contact, neutrophil, and platelet activation systems during simulated extracorporeal perfusion.  J Thorac Cardiovasc Surg. 1993;  106 1-9
    PubMedGoogle Scholar
  • 42 ELSO .The Registry of the Extracorporeal Life Support Organization (updated annually). Ann Arbor; Extracorporeal Life Support Organization
    Google Scholar
  • 43 Winternitz M C, Smith G H. Preliminary Studies in Intratracheal Therapy: Pathology of War Gas Poisoning. New Haven; Yale University Press 1920
    Google Scholar
  • 44 Tham M K, Walker R D, Modell J H. Physical properties and gas solubilities in selected fluorinated ethers.  Jour Chem Engr Data. 1973;  18 385-386
    PubMedGoogle Scholar
  • 45 Cox C A, Wolfson M R, Shaffer T H. Liquid ventilation: a comprehensive overview.  Neonatal Netw. 1996;  15 31
    PubMedGoogle Scholar
  • 46 Fuhrman B P, Paczan P R, De Francis M. Perfluorocarbon associated gas exchange.  Crit Care Med. 1991;  19 712-722
    PubMedGoogle Scholar
  • 47 Tutuncu A S, Faithful N S, Lachmann B. Comparison of ventilatory support with intratracheal perfluorocarbon (PFC) administration and conventional mechanical ventilation in animals with acute respiratory failure.  Am Rev Respir Dis. 1993;  148 785
    PubMedGoogle Scholar
  • 48 Wolfson M R, Kechner N E, Friss H et al.. Improved gas exchange and pulmonary mechanics during and following slow tracheal instillation of perfluorochemical liquid in neonatal respiratory distress [abstract].  Am Rev Respir Dis. 1994;  149 A545
    PubMedGoogle Scholar
  • 49 Greenspan J S. Physiology and clinical role of liquid ventilation therapy.  J Perinatol. 1996;  16 S47
    PubMedGoogle Scholar
  • 50 Koen P A, Wolfson M R, Shaffer T H. Fluorocarbon ventilation: Maximal expiratory flows and carbon dioxide elimination.  Pediatr Res. 1988;  24 291
    PubMedGoogle Scholar
  • 51 Lowe C, Shaffer T H. Pulmonary vascular resistance in the fluorocarbon-filled lung.  J Appl Physiol. 1986;  60 154
    PubMedGoogle Scholar
  • 52 Harris R S, Willey-Courand D B, Head C A et al.. Regional VA, Q, and VA/Q during PLV: effects of nitroprusside and inhaled nitric oxide.  J Appl Physiol. 2002;  92 297
    PubMedGoogle Scholar
  • 53 Smith T M, Steinhorn D M, Thusu K et al.. A liquid perfluorochemical decreases the in vitro production of reactive oxygen species by alveolar macrophages.  Crit Care Med. 1995;  23 1533
    PubMedGoogle Scholar
  • 54 Varani J, Hirschl R B, Dame M et al.. Perfluorocarbon protects lung epithelial cells from neutrophil-mediated injury in an in vitro model of liquid ventilation therapy.  Shock. 1996;  6 339
    PubMedGoogle Scholar
  • 55 Woods C M, Neslund G, Kornbrust E et al.. Perflubron attenuates neutrophil adhesion to activated endothelial cells in vitro.  Am J Physiol Lung Cell Mol Physiol. 2000;  278 L1008
    PubMedGoogle Scholar
  • 56 Quintel M et al.. Computer Tomographic (CT) Assessment of Perfluorocarbon and Gas Distribution During Partial Liquid Ventilation in the Setting of Acute Respiratory Failure.  Am J Respir Crit Care Med. 1998;  158 249-255
    PubMedGoogle Scholar
  • 57 Nesti F D et al.. Perfluorocarbon-associated gas exchange in gastric aspiration.  Crit Care Med. 1994;  22 1445-1452
    PubMedGoogle Scholar
  • 58 Hirschl R B et al.. Liquid ventilation improves pulmonary function, gas exchange, and lung injury in a model of respiratory failure.  Ann Surg. 1995;  221 79-88
    PubMedGoogle Scholar
  • 59 Rotta A T, Steinhorn D M. Partial liquid ventilation reduces pulmonary neutrophil accumulation in an experimental model of systemic endotoxemia and acute lung injury.  Crit Care Med. 1998;  26 1707-1715
    PubMedGoogle Scholar
  • 60 Reickert C, Pranikoff T, Overbeck M et al.. The pulmonary and systemic distribution and elimination of perflubron from adult patients treated with partial liquid ventilation.  Chest. 2001;  119 515
    CrossrefPubMedGoogle Scholar
  • 61 Shaffer T H, Wolfson M R, Clark Jr L C. Liquid ventilation.  Pediatr Pulmonol. 1992;  14 102
    PubMedGoogle Scholar
  • 62 Shaffer T H, Wolfson M R, Greenspan J S et al.. Liquid ventilation: uptake, biodistribution and elimination of perfluorochemical (PFC) liquid [abstract].  Pediatr Res. 1992;  31 223A
    PubMedGoogle Scholar
  • 63 Leach C L, Greenspan J S, Rubenstein D et al.. Partial liquid ventilation with perflubron in premature infants with severe respiratory distress syndrome.  N Engl J Med. 1996;  335 761
    CrossrefPubMedGoogle Scholar
  • 64 Hirschl R B, Pranikoff T, Wise C et al.. Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome.  JAMA. 1996;  275 383
    CrossrefPubMedGoogle Scholar
  • 65 Richman P S, Wolfson M R, Shaffer T H. Lung lavage with oxygenated perfluorochemical liquid in acute lung injury.  Crit Care Med. 1993;  21 768
    PubMedGoogle Scholar
  • 66 Hirschl R B, Parent A, Tooley R et al.. Liquid ventilation improves pulmonary function, gas exchange and lung injury in a model of respiratory failure.  Ann Surg. 1995;  221 79
    PubMedGoogle Scholar
  • 67 Curtis S E, Peek J T, Kelly D R. Partial liquid breathing with perflubron improves arterial oxygenation in acute canine lung injury.  J Appl Physiol. 1993;  75 2696
    PubMedGoogle Scholar
  • 68 Shaffer T H, Lowe C A, Bhutani V K, Douglas P R. Liquid ventilation: effects on pulmonary function, gas exchange and lung injury in a model of respiratory failure.  Pediatr Res. 1984;  18 47
    PubMedGoogle Scholar
  • 69 Hirschl R B, Conrad S, Kaiser R et al.. Partial liquid ventilation in adult patients with ARDS: a multicenter phase I-II trial. Adult PLV Study Group.  Ann Surg. 1998;  228 692
    CrossrefPubMedGoogle Scholar
  • 70 Gauger P G et al.. Initial experience with partial liquid ventilation in pediatric patients with the acute respiratory distress syndrome.  Crit Care Med. 1996;  24 16-22
    CrossrefPubMedGoogle Scholar
  • 71 Toro-Figueroa L O et al.. Perflubron partial liquid ventilation (PLV) in children with ARDS: a safety and efficacy pilot study [abstract].  Crit Care Med. 1996;  24 A150
    PubMedGoogle Scholar
  • 72 Hirschl R B, Croce M, Gore D et al.. Prospective, randomized, controlled pilot study of partial liquid ventilation in adult acute respiratory distress syndrome.  Am J Respir Crit Care Med. 2002;  165 781
    PubMedGoogle Scholar
  • 73 Wiedemann, Alliance Pharmaceutical Corp .Announces Preliminary Results of LiquiVent Phase 2-3 Clinical Study. 2001
    Google Scholar

Ronald B HirschlM.D. 

Department of Surgery, University of Michigan Medical Center

1500 East Medical Center Dr., Mott Hospital F3970, Box 0245, Ann Arbor, MI 48109

Email: rhirschl@med.umich.edu

      >