Extracorporeal Membrane Oxygenation for ARDS in Adults

N Engl J Med. 2011 Nov 17;365(20):1905-14. doi: 10.1056/NEJMct1103720.

Abstract

A 41-year-old woman presents with severe community-acquired pneumococcal pneumonia. Chest radiography reveals diffuse bilateral infiltrates, and hypoxemic respiratory failure develops despite appropriate antibiotic therapy. She is intubated and mechanical ventilation is initiated with a volume- and pressure-limited approach for the acute respiratory distress syndrome (ARDS). Over the ensuing 24 hours, her partial pressure of arterial oxygen (Pao2) decreases to 40 mm Hg, despite ventilatory support with a fraction of inspired oxygen (Fio2) of 1.0 and a positive end-expiratory pressure (PEEP) of 20 cm of water. She is placed in the prone position and a neuromuscular blocking agent is administered, without improvement in her Pao2. An intensive care specialist recommends the initiation of extracorporeal membrane oxygenation (ECMO).

Publication types

  • Review

MeSH terms

  • Adult
  • Community-Acquired Infections / complications
  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Extracorporeal Membrane Oxygenation* / methods
  • Female
  • Humans
  • Hypoxia / etiology
  • Hypoxia / therapy
  • Pneumonia, Pneumococcal / complications
  • Practice Guidelines as Topic
  • Respiratory Distress Syndrome, Adult / etiology
  • Respiratory Distress Syndrome, Adult / therapy*