Pulmonary complications associated with veno-arterial extra-corporeal membrane oxygenation: a comprehensive review.
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11 mai 2020
- doi: 10.1186/s13054-020-02937-z
- issn: 1364-8535
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info:eu-repo/semantics/altIdentifier/doi/10.1186/s13054-020-02937-z
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info:eu-repo/semantics/altIdentifier/pmid/32393326
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info:eu-repo/semantics/altIdentifier/eissn/1466-609X
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info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_5A1F7D198E192
info:eu-repo/semantics/openAccess , CC BY 4.0 , https://creativecommons.org/licenses/by/4.0/
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A. Roumy et al., « Pulmonary complications associated with veno-arterial extra-corporeal membrane oxygenation: a comprehensive review. », Serveur académique Lausannois, ID : 10.1186/s13054-020-02937-z
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Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving technology that provides transient respiratory and circulatory support for patients with profound cardiogenic shock or refractory cardiac arrest. Among its potential complications, VA-ECMO may adversely affect lung function through various pathophysiological mechanisms. The interaction of blood components with the biomaterials of the extracorporeal membrane elicits a systemic inflammatory response which may increase pulmonary vascular permeability and promote the sequestration of polymorphonuclear neutrophils within the lung parenchyma. Also, VA-ECMO increases the afterload of the left ventricle (LV) through reverse flow within the thoracic aorta, resulting in increased LV filling pressure and pulmonary congestion. Furthermore, VA-ECMO may result in long-standing pulmonary hypoxia, due to partial shunting of the pulmonary circulation and to reduced pulsatile blood flow within the bronchial circulation. Ultimately, these different abnormalities may result in a state of persisting lung inflammation and fibrotic changes with concomitant functional impairment, which may compromise weaning from VA-ECMO and could possibly result in long-term lung dysfunction. This review presents the mechanisms of lung damage and dysfunction under VA-ECMO and discusses potential strategies to prevent and treat such alterations.