This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (336)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Luciano Gattinoni, MD; Antonio Pesenti, MD; Daniele Mascheroni, MD; Roberto Marcolin, MD; Roberto Fumagalli, MD; Francesca Rossi, MD; Gaetano lapichino, MD; Giuliano Romagnoli, MD; Ljli Uziel, MD; Angelo Agostoni, MD; Theodor Kolobow, MD; Giorgio Damia, MD

JAMA. 1986;256(7):881-886.

Abstract
Forty-three patients were entered in an uncontrolled study designed to evaluate extracorporeal membrane lung support in severe acute respiratory failure of parenchymal origin. Most of the metabolic carbon dioxide production was cleared through a low-flow venovenous bypass. To avoid lung injury from conventional mechanical ventilation, the lungs were kept "at rest" (three to five breaths per minute) at a low peak airway pressure of 35 to 45 cm H₂O (3.4 to 4.4 kPa). The entry criteria were based on gas exchange under standard ventilatory conditions (expected mortality rate, >90%). Lung function improved in thirty-one patients (72.8%), and 21 patients (48.8%) eventually survived. The mean time on bypass for the survivors was 5.4 ± 3.5 days. Improvement in lung function, when present, always occurred within 48 hours. Blood loss averaged 1800±850 mL/d. No major technical accidents occurred in more than 8000 hours of perfusion. Extracorporeal carbon dioxide removal with low-frequency ventilation proved a safe technique, and we suggest it as a valuable tool and an alternative to treating severe acute respiratory failure by conventional means.

(JAMA 1986;256:881-886)

Author Affiliations
From the Istituto di Anestesia e Rianimazione (Drs Gattinoni, Pesenti, Mascheroni, Marcolin, Fumagalli, Rossi, lapichino, and Damia), the Istituto di Clinica Chirurgia III (Dr Romagnoli), and the Istituto di Clinica Medica V (Drs Uziel and Agostoni), Universita di Milano, Milan, Italy; and the Laboratory of Technical Development, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Dr Kolobow).

Footnotes
Reprint requests to Istituto di Anestesia e Rianimazione, Via F Sforza 35, 20122-Milano, Italy (Dr Gattinoni).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Optimal Time for Initiating Extracorporeal Membrane Oxygenation
Haile and Schears
SEMIN CARDIOTHORAC VASC ANESTH 2009;13:146-153.
ABSTRACT  

Veno-Venous Extracorporeal Membrane Oxygenation in Surgery for Bronchial Repair
Korvenoja et al.
Ann. Thorac. Surg. 2008;86:1348-1349.
ABSTRACT | FULL TEXT  

Extracorporeal lung membrane provides better lung protection than conventional treatment for severe postpneumonectomy noncardiogenic acute respiratory distress syndrome.
Iglesias et al.
J. Thorac. Cardiovasc. Surg. 2008;135:1362-1371.e4.
ABSTRACT | FULL TEXT  

Extrapulmonary Ventilation for Unresponsive Severe Acute Respiratory Distress Syndrome After Pulmonary Resection
Iglesias et al.
Ann. Thorac. Surg. 2008;85:237-244.
ABSTRACT | FULL TEXT  

Ventilator-associated lung injury: a search for better therapeutic targets
Oeckler and Hubmayr
Eur Respir J 2007;30:1216-1226.
ABSTRACT | FULL TEXT  

Extracorporeal membrane oxygenation in respiratory failure for pulmonary contusion and bronchial disruption after trauma
Campione et al.
J. Thorac. Cardiovasc. Surg. 2007;133:1673-1674.
FULL TEXT  

Artificial lungs: a new inspiration
Zwischenberger and Alpard
Perfusion 2002;17:253-268.
ABSTRACT  

Treatment of ARDS
Brower et al.
Chest 2001;120:1347-1367.
ABSTRACT | FULL TEXT  

An extracorporeal membrane oxygenation-based approach to cardiogenic shock in an older population
Smith et al.
Ann. Thorac. Surg. 2001;71:1421-1427.
ABSTRACT | FULL TEXT  

Severe respiratory failure
Zwischenberger et al.
Ann. Thorac. Surg. 2001;71:394-396.
FULL TEXT  

Extracorporeal Life Support: The University of Michigan Experience
Bartlett et al.
JAMA 2000;283:904-908.
ABSTRACT | FULL TEXT  

Extracorporeal lung support in a patient with traumatic brain injury: the benefit of heparin-bonded circuitry
Reynolds et al.
Perfusion 1999;14:489-493.
 

Percutaneous extracorporeal arteriovenous CO2 removal for severe respiratory failure
Zwischenberger et al.
Ann. Thorac. Surg. 1999;68:181-187.
ABSTRACT | FULL TEXT  

Extracorporeal membrane oxygenation
Firmin and Killer
Perfusion 1999;14:291-297.
 

Arteriovenous carbon dioxide removal: development and impact on ventilator management and survival during severe respiratory failure
Zwischenberger et al.
Perfusion 1999;14:299-310.
 

Venovenous Extracorporeal Life Support Via Percutaneous Cannulation in 94 Patients
Pranikoff et al.
Chest 1999;115:818-822.
ABSTRACT | FULL TEXT  

Blast Lung Injury From an Explosion on a Civilian Bus
Pizov et al.
Chest 1999;115:165-172.
ABSTRACT | FULL TEXT  

A prospective comparison of atrio-femoral and femoro-atrial flow in adult venovenous extracorporeal life support
Rich et al.
J. Thorac. Cardiovasc. Surg. 1998;116:628-632.
ABSTRACT | FULL TEXT  

The Relation of Pneumothorax and Other Air Leaks to Mortality in the Acute Respiratory Distress Syndrome
Weg et al.
NEJM 1998;338:341-346.
ABSTRACT | FULL TEXT  

Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome
Amato et al.
NEJM 1998;338:347-354.
ABSTRACT | FULL TEXT  

Evaluation of a Ventilation Strategy to Prevent Barotrauma in Patients at High Risk for Acute Respiratory Distress Syndrome
Stewart et al.
NEJM 1998;338:355-361.
ABSTRACT | FULL TEXT  

Adult extracorporeal membrane oxygenation for severe respiratory failure
Alpard and Zwischenberger
Perfusion 1998;13:3-15.
 

Is Extracorporeal CO2Removal an Option in the Treatment of Adult Respiratory Distress Syndrome?
Deslauriers and Awad
Ann. Thorac. Surg. 1997;64:1581-1582.
FULL TEXT  

PROLONGED HEMODYNAMIC STABILITY DURING ARTERIOVENOUS CARBON DIOXIDE REMOVAL FOR SEVERE RESPIRATORY FAILURE
Brunston et al.
J. Thorac. Cardiovasc. Surg. 1997;114:1107-1114.
ABSTRACT | FULL TEXT  

Temporal Hemodynamic Effects of Permissive Hypercapnia Associated with Ideal PEEP in ARDS
RIBEIRO CARVALHO et al.
Am. J. Respir. Crit. Care Med. 1997;156:1458-1466.
ABSTRACT | FULL TEXT  

Extracorporeal Membrane Oxygenation Using a Centrifugal Pump and a Servo Regulator to Prevent Negative Inlet Pressure
Pedersen et al.
Ann. Thorac. Surg. 1997;63:1333-1339.
ABSTRACT | FULL TEXT  

Ventilator-induced Lung Injury . Lessons from Experimental Studies
DREYFUSS and SAUMON
Am. J. Respir. Crit. Care Med. 1997;157:294-323.
FULL TEXT  

Clinical Use of Extracorporeal Lung Assist for a Patient in Status Asthmaticus
Sakai et al.
Ann. Thorac. Surg. 1996;62:885-887.
ABSTRACT | FULL TEXT  

Pathogenesis and Treatment of the Adult Respiratory Distress Syndrome
Fulkerson et al.
Arch Intern Med 1996;156:29-38.
ABSTRACT  

Influence of Hemodynamics on the Performances of Intravascular Gas Exchangers
Mihaljevic et al.
Ann. Thorac. Surg. 1995;60:1665-1670.
ABSTRACT | FULL TEXT  

Improved Survival of Patients With Acute Respiratory Distress Syndrome (ARDS): 1983-1993
Milberg et al.
JAMA 1995;273:306-309.
ABSTRACT  

The Acute Respiratory Distress Syndrome
Kollef and Schuster
NEJM 1995;332:27-37.
FULL TEXT  

Permissive Hypercapnia in Acute Respiratory Failure
Bidani et al.
JAMA 1994;272:957-962.
ABSTRACT  

Airway Pressure Release Ventilation
Davis et al.
Arch Surg 1993;128:1348-1352.
ABSTRACT  

The ARDS Lung: New Insights From Computed Tomography
Bone
JAMA 1993;269:2134-2135.
ABSTRACT  

Extracorporeal membrane oxygenation in the 1990s- a personal view
Firmin
Perfusion 1991;6:161-166.
 

Science versus Opinion: A Response to Cunningham's Critique
Leventhal et al.
J Hum Lact 1989;5:126-128.
 

Extracorporeal Membrane Oxygenation for Acute Respiratory Failure
Bone
JAMA 1986;256:910-910.
ABSTRACT