Extracorporeal Membrane Oxygenation for ARDS in Adults

A 41-year-old woman presents with severe pneumonia, and the acute respiratory distress syndrome (ARDS) develops. Despite mechanical ventilation, her oxygenation deteriorates. The use of extracorporeal membrane oxygenation (ECMO) is recommended. Foreword This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the authors' clinical recommendations. Stage 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 (PaO 2 ) decreases to 40 mm Hg, despite ventilatory support with a fraction of inspired oxygen (FIO 2 ) 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 . . .