Partial Extracorporeal Support

We have previously seen that the efficiency of VV-ECMO in providing CO₂ removal is much higher than the efficiency in delivering oxygen and that a high amount of CO₂ can be removed from the ML with lower ECBF requiring smaller cannulas and simpler systems. The key advantage of removing CO2 through these devices is that it is possible to reduce the minute ventilation required through the native lung. Potential indications include:

• 1. Decrease of ventilatory needs in patients with exacerbations of chronic obstructive pulmonary disease (COPD) or severe asthma, to reduce dynamic hyperinflation and avoid endotracheal intubation or facilitate weaning from mechanical ventilation [117-122].
• 2. Immunocompromised patients, with the goal of facilitating extubation or even avoiding intubation.
• 3. Bridge to lung transplantation [123-128].
• 4. Decrease of tidal volume, respiratory rate and plateau airway pressure in ARDS patients for “ultraprotective ventilation”. In this chapter we will focus on the use of partial VV-ECMO for ultraprotective ventilation in ARDS patients.