DOI: 10.1177/02676591231210461 ISSN: 0267-6591

State of the art: Monitoring of the respiratory system during veno-venous extracorporeal membrane oxygenation

Patrick Duncan Collins, Lorenzo Giosa, Luigi Camporota, Nicholas A Barrett
  • Advanced and Specialized Nursing
  • Cardiology and Cardiovascular Medicine
  • Safety Research
  • Radiology, Nuclear Medicine and imaging
  • General Medicine

Monitoring the patient receiving veno-venous extracorporeal membrane oxygenation (VV ECMO) is challenging due to the complex physiological interplay between native and membrane lung. Understanding these interactions is essential to understand the utility and limitations of different approaches to respiratory monitoring during ECMO. We present a summary of the underlying physiology of native and membrane lung gas exchange and describe different tools for titrating and monitoring gas exchange during ECMO. However, the most important role of VV ECMO in severe respiratory failure is as a means of avoiding further ergotrauma. Although optimal respiratory management during ECMO has not been defined, over the last decade there have been advances in multimodal respiratory assessment which have the potential to guide care. We describe a combination of imaging, ventilator-derived or invasive lung mechanic assessments as a means to individualise management during ECMO.

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