EXTRACORPOREAL MEMBRANE OXYGENATION IN CLINICAL PRACTICE: LITERATURE REVIEW
Abstract
Extracorporeal membrane oxygenation (ECMO) is a method of maintaining adequate cardiac output, oxygenation and gas exchange in patients with refractory shock and decompensated respiratory failure, when other treatments are ineffective. The publication provides historical information and an overview of modern research on the use of ECMO in adults and children in critical condition. It has been demonstrated that over the past decade, the frequency of ECMO use has increased significantly, which has significantly improved treatment outcomes, however, the main limiting factor is the timing of initiation and the duration of the operation, since when ECMO is connected in the later stages of the disease, the likelihood of failure increases significantly. It is indicated that the use of veno-arterio-venous ECMO is most effective in the treatment of critical respiratory failure associated with cardiogenic shock or end-stage lung disease. It is reflected that the main complications of ECMO include artery damage, compression syndrome, infection, stroke, acute kidney injury, bleeding and the need for blood transfusion. Marked, that the use of a central VA-ECMO connection in cardiac surgery is associated with greater in-hospital mortality. It was found that the use of levosimendan contributed to faster and smoother weaning from a respirator and improved survival of patients with cardiogenic or postcardiotomy shock. Particular attention is paid to the use of ECMO in toxicology, obstetrics and pediatric practice. Data on the high effectiveness of ECMO use in adults and children with acute poisoning with corticotropic toxicants are presented, which indicates the need for wider use of this technique in patients with a toxicological profile, especially in the early stages when there are signs of small cardiac output syndrome and cardiogenic shock. The results of studies indicating the safety and sufficient effectiveness of ECMO use during pregnancy when used in a specialized center are indicated, the maximum survival rates in pregnant women were noted when using ECMO for cardiac indications.
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