Veno-venous extracorporeal membrane oxygenation in the treatment of severe respiratory failure (literature review)
https://doi.org/10.24884/2078-5658-2025-22-3-119-128
Abstract
The objective was to summarize the available data on the use of V-V ECMO (veno–venous extracorporeal membrane oxygenation) in severe respiratory failure and to update ideas about the tactics of intensive therapy.
Materials and methods. In this review, we searched Web of Science, Scopus, Medline, PubMed, and E-library database. 48 articles were included, containing modern approaches to V-V ECMO, as well as current data of clinical and scientific studies.
Results. In this review, we presented the physiologic aspects of V-V ECMO, indications for its use and data on its effectiveness in the treatment of severe respiratory failure of various etiologies. Current clinical data on management tactics and aspects of intensive care are presented.
Conclusions. Ensuring “Lung rest” with the creation of conditions for the restoration of lung gas exchange function is the main point of application of V-V ECMO in intensive care for severe respiratory failure. Individualized approach to the assessment of indications and timely initiation of the method in multidisciplinary institutions with extensive experience are key factors that improve the treatment outcomes of patients in this group.
About the Authors
K. A. Mikaelian
Moscow City Clinical Hospital № 52; A. S. Puchkov Station of Emergency Medical Care; Peoples’ Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
Mikaelian Karen A. - Anesthesiologist and Intensivist, ICU № 7; Anesthesiologist and Intensivist o f the Emergency ECMO Team
3, Pekhotnaya str., Moscow, 123182
3, 1st Koptelsky Lane, Moscow, 129090
M. V. Petrova
Peoples’ Friendship University of Russia named after Patrice Lumumba; Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology
Russian Federation
Russian Federation
Petrova Marina V. - Dr. of Sci. (Med.), Professor, Deputy Director for Scientific and Clinical Work; Anesthesiologist and Intensivist, Head of the Department of Anesthesiology and Intensive Care with the Course of Medical Rehabilitation
25, build. 2, Petrovka str., Moscow, 107031
6, Miklukho-Maklaya str., Moscow, 117198
E. V. Filimonova
Moscow City Clinical Hospital № 52; Lomonosov Moscow State University
Russian Federation
Russian Federation
Filimonova Elena V. - Anesthesiologist and Intensivist, ICU № 7; Assistant Anesthesiology and Intensive Care Department
3, Pekhotnaya str., Moscow, 123182
27, build. 1, Lomonosovsky pr., Moscow, 119192
Zh. V. Zhakova
Lomonosov Moscow State University
Russian Federation
Russian Federation
Zhakova Zhanna V. - Resident of Anesthesiology and Intensive Care Department
27, build. 1, Lomonosovsky pr., Moscow, 119192
References
1. Bakharev S. A., Popugaev K. A., Kiselev K. V. et al. Mechanisms of hemorrhagic complications during extracorporeal membrane oxygenation. A pilot study. Russian Journal of Anesthesiology and Reanimatology, 2020, no. 1, pp. 25–34. (In Russ.). https://doi.org/10.17116/anaesthesiology202001125.
2. Yaroshetsky A. I., Gritsan A. I., Avdeev S. N. et al. Diagnostics and intensive therapy of Acute Respiratory Distress Syndrome (Clinical guidelines of the Federation of Anesthesiologists and Reanimatologists of Russia). Russian Journal of Anesthesiology and Reanimatology, 2020, no. 2, pp. 5–39. (In Russ.). https://doi.org/10.17116/anaesthesiology20200215.
3. Arbor Ann ELSO General Guidelines Extracorporeal Life Support Organization (ELSO) General Guidelines for all ECLS Cases // ELSO. – 2017. URL: https://www.elso.org/ecmo-resources/elso-ecmo-guidelines.aspx (accessed: 20.04.2025).
4. Badulak J., Antonini M. V., Stead C. M. et al. ELSO COVID-19 Working Group Members. Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization // ASAIO J – 2021. – Vol. 67, № 5. – P. 485–495. https://doi.org/10.1097/MAT.0000000000001422.
5. Bartlett R. H. Physiology of extracorporeal gas exchange // Compr Physiol. – 2020. – Vol. 10, № 3. – P. 879–891. https://doi.org/10.1002/cphy.c190006.
6. Agerstrand C., Abrams D., Bacchetta M. et al. Endotracheal extubation in patients with respiratory failure receiving venovenous ECMO // ELSO. – 2015. URL: https://www.elso.org/Portals/0/Files/ELSO_ExtubationGuide-lines_May2015.pdf (accessed: 20.04.2025).
7. Collins P. D., Giosa L., Camarda V. et al. Physiological adaptations during weaning from veno-venous extracorporeal membrane oxygenation // Intensive Care Med Exp. – 2023. – Vol. 11, № 1. – P. 7. https://doi.org/10.1186/s40635-023-00493-8.
8. Combes A., Hajage D., Capellier G. et al. EOLIA Trial Group, REVA, and ECMONet. extracorporeal membrane oxygenation for severe acute respiratory distress syndrome // N Engl J Med. – 2018. – Vol. 378, № 21. – P. 1965–1975. https://doi.org/10.1056/NEJMoa1800385.
9. Conrad S. A., Wang D. Evaluation of recirculation during venovenous extracorporeal membrane oxygenation using computational fluid dynamics incorporating fluid-structure interaction // ASAIO J. – 2021. – Vol. 67, № 8. – P. 943–953. https://doi.org/10.1097/MAT.0000000000001314.
10. DeGrado J. R., Szumita P. M., Schuler B. R. et al. Evaluation of the efficacy and safety of inhaled epoprostenol and inhaled nitric oxide for refractory hypoxemia in patients with coronavirus disease 2019 // Crit Care Explor. – 2020. – Vol. 2, № 10. – e0259. https://doi.org/10.1097/CCE.0000000000000259.
11. Extracorporeal Life Support Organization ELSO Live Registry Dashboard of ECMO Patient Data // ELSO. URL: https://www.elso.org/registry/elsoliveregistrydashboard.aspx (accessed: 20.04.2025)
12. Fan E., Gattinoni L., Combes A. et al. Venovenous extracorporeal membrane oxygenation for acute respiratory failure: A clinical review from an international group of experts // Intensive Care Med. – 2016. – Vol. 42, № 5. – P. 712–724. https://doi.org/10.1007/s00134-016-4314-7.
13. Ficial B., Vasques F., Zhang J. et al. Physiological basis of extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal in respiratory failure // Membranes (Basel). – 2021. – Vol. 11, № 3. – P. 225. https://doi.org/10.3390/membranes11030225.
14. Frenckner B., Broman M., Broomé M. Position of draining venous cannula in extracorporeal membrane oxygenation for respiratory and respiratory/circulatory support in adult patients // Crit Care. – 2018. – Vol. 22, № 1. – P. 163. https://doi.org/10.1186/s13054-018-2083-0.
15. Fumagalli B., Giani M., Bombino M. et al. Pressure support ventilation during extracorporeal membrane oxygenation support in patients with acute respiratory distress syndrome // ASAIO J. – 2025. – Vol. 71, № 2. – P. 171–176. https://doi.org/10.1097/MAT.0000000000002285.
16. Gajkowski E. F., Herrera G., Hatton L. ELSO Guidelines for adult and pediatric extracorporeal membrane oxygenation circuits // ASAIO J. – 2022. – Vol. 68, № 2. – P. 133–152. https://doi.org/10.1097/MAT.0000000000001630.
17. García-de-Acilu M., Pacheco A., Santafé M. et al. Effects of prone position in patients with COVID-19 treated with extracorporeal membrane oxygenation: a physiologic study, CHEST // Critical Care. – 2023. – Vol. 1, № 2. – P. 1–5. https://doi.org/10.1016/j.chstcc.2023.100010.
18. Herrmann J., Lotz C., Karagiannidis C. et al. ECMO COVID Study Group. Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation // Crit Care. – 2022. – Vol. 26, № 1. – P. 190. https://doi.org/10.1186/s13054-022-04053-6.
19. Riera J., Alcántara S., Bonilla C. et al. Risk factors for mortality in patients with COVID-19 needing extracorporeal respiratory support // Eur Respir J. – 2022. – Vol. 59, № 2. – 2102463. https://doi.org/10.1183/13993003.02463-2021.
20. Liu K., Wang H., Yu S. J. et al. Inhaled pulmonary vasodilators: a narrative review // Ann Transl Med. – 2021. – Vol. 9, № 7. – P. 597. https://doi.org/10.21037/atm-20-4895.
21. Lorusso R., Raffa G.M., Heuts S. et al. Pulmonary artery cannulation to enhance extracorporeal membrane oxygenation management in acute cardiac failure // Interact Cardiovasc Thorac Surg. – 2020. – Vol. 30, № 2. – P. 215–222. https://doi.org/10.1093/icvts/ivz245.
22. Martucci G., Giani M., Schmidt M. et al. Anticoagulation and bleeding during veno-venous extracorporeal membrane oxygenation: insights from the PROTECMO study // Am J Respir Crit Care Med. – 2024. – Vol. 209, № 4. – P. 417–426. https://doi.org/10.1164/rccm.202305-0896OC.
23. Mazzeffi M., Curley J., Gallo P. et al. Variation in hospitalization costs, charges, and lengths of hospital stay for coronavirus disease 2019 patients treated with venovenous extracorporeal membrane oxygenation in the United States: a cohort study // J Cardiothorac Vasc Anesth. – 2023. – Vol. 37, № 8. – P. 1449–1455. https://doi.org/10.1053/j.jvca.2023.04.001.
24. McMichael A. B. V., Ryerson L. M., Ratano D. et al. 2021 ELSO adult and pediatric anticoagulation guidelines // ASAIO J. – 2022. – Vol. 68, № 3. – P. 303–310. https://doi.org/10.1097/MAT.0000000000001652.
25. Mohamed A., Saeed O., Fazzari M. et al. “Awake” cannulation of patients for venovenous extracorporeal membrane oxygen: an analysis of the extracorpo real life support organization registry // Crit Care Explor. – 2024. – Vol. 6, № 12. – P. e1181. https://doi.org/10.1097/CCE.0000000000001181.
26. Napp L. C., Bauersachs J. Triple cannulation ECMO // InTech. – 2016. – P. 79–99. https://doi.org/10.5772/63392.
27. Nasrullah A., Virk S., Shah A. et al. Acute respiratory distress syndrome and the use of inhaled pulmonary vasodilators in the COVID-19 era: a narrative review // Life (Basel). – 2022. – Vol. 12, № 11. – P. 1766. https://doi.org/10.3390/life12111766.
28. Oude Lansink-Hartgring A., van Minnen O., Vermeulen K. M. et al. Dutch extracorporeal life support study group. Hospital costs of extracorporeal membrane oxygenation in adults: a systematic review // Pharmacoecon Open. – 2021. – Vol. 5, № 4. – P. 613–623. https://doi.org/10.1007/s41669-021-00272-9.
29. Papazian L., Schmidt M., Hajage D. et al. Effect of prone positioning on survival in adult patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis // Intensive Care Med. – 2022. – Vol. 48, № 3. – P. 270–280. https://doi.org/10.1007/s00134-021-06604-x.
30. Patel B., Arcaro M., Chatterjee S. Bedside troubleshooting during venovenous extracorporeal membrane oxygenation (ECMO) // J Thorac Dis. – 2019. – Vol. 11, Suppl 14. – S1698–S1707. https://doi.org/10.21037/jtd.2019.04.81.
31. De Paulis S., Cavaliere F. Anticoagulation management in high bleeding-risk ECMO in adults // Front Cardiovasc Med. – 2022. – Vol. 9. – 884063. https://doi.org/10.3389/fcvm.2022.884063.
32. Peek G. J., Mugford M., Tiruvoipati R. et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial // Lancet. – 2009. – Vol. 374, № 9698. – P. 1351–1363. https://doi.org/10.1016/S0140-6736(09)61069-2.
33. Rampon G. L., Simpson S. Q., Agrawal R. Prone positioning for acute hypoxemic respiratory failure and ARDS: a review // Chest. – 2023. – Vol. 163, № 2. – P. 332–340. https://doi.org/10.1016/j.chest.2022.09.020.
34. Roca O., Pacheco A., García-de-Acilu M. To prone or not to prone ARDS patients on ECMO // Crit Care. – 2021. – Vol. 25, № 1. – P. 315. https://doi.org/10.1186/s13054-021-03675-6.
35. Rodrigues A. B., Rodrigues A., Correia C. J. et al. Anticoagulation management in V-V ECMO patients: a multidisciplinary pragmatic protocol // J Clin Med. – 2024. – Vol. 13, № 3. – P. 719. https://doi.org/10.3390/jcm13030719.
36. Roncon-Albuquerque R. Jr., Gaião S., Vasques-Nóvoa F. et al. Standardized approach for extubation during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome: a prospective observational study // Ann Intensive Care. – 2023. – Vol. 13, № 1. – P. 86. https://doi.org/10.1186/s13613-023-01185-y.
37. Salas De Armas I. A., Dinh K., Akkanti B. et al. Tracheostomy while on extracorporeal membrane oxygenation: a comparison of percutaneous and open procedures // J Extra Corpor Technol. – 2020. – Vol. 52, № 4. – P. 266–271. https://doi.org/10.1182/ject-2000027.
38. Schmidt M., Hajage D., Lebreton G. et al. Prone positioning during extracorporeal membrane oxygenation in patients with severe ARDS: The PRONECMO randomized clinical trial // JAMA. – 2023. – Vol. 330, № 24. – P. 2343–2353. https://doi.org/10.1001/jama.2023.24491.
39. Shekar K., Badulak J., Peek G. et al. Extracorporeal life support organization coronavirus disease 2019 interim guidelines: a consensus document from an international group of interdisciplinary extracorporeal membrane oxygenation providers // ASAIO J. – 2020. – Vol. 66, № 7. – P. 707–721. https://doi.org/10.1097/MAT.0000000000001193.
40. Sonti R., Pike C. W., Cobb N. Responsiveness of inhaled epoprostenol in respiratory failure due to COVID-19 // J Intensive Care Med. – 2021. – Vol. 36, № 3. – P. 327–333. https://doi.org/10.1177/0885066620976525.
41. Al Sulaiman K., Korayem G. B., Altebainawi A. F. et al. Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: a multicenter cohort study // Crit Care. – 2022. – Vol. 26, № 1. – P. 304. https://doi.org/10.1186/s13054-022-04158-y.
42. Mustafa A. K., Alexander P. J., Joshi D. J. et al. Extracorporeal membrane oxygenation for patients with COVID-19 in severe respiratory failure // JAMA Surg. – 2020. – Vol. 155, № 10. – P. 990–992. https://doi.org/10.1001/jamasurg.2020.3950.
43. Tonna J. E., Abrams D., Brodie D. et al. Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): guideline from the extracorporeal life support organization (ELSO) // ASAIO J. – 2021. – Vol. 67, № 6. – P. 601–610. https://doi.org/10.1097/MAT.0000000000001432.
44. Tran A., Fernando S. M., Rochwerg B. et al. Prognostic factors associated with mortality among patients receiving venovenous extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis // Lancet Respir Med. – 2023. – Vol. 11, № 3. – P. 235–244. https://doi.org/10.1016/S2213-2600(22)00296-X.
45. Tsiouris A., Protos A. N., Saikus C. E. et al. Fundamentals of weaning veno-arterial and veno-venous extracorporeal membrane oxygenation // Indian J Thorac Cardiovasc Surg. – 2023. – Vol. 39, Suppl 1. – P. 1–11. https://doi.org/10.1007/s12055-023-01474-y.
46. Upchurch C., Blumenberg A., Brodie D. et al. Extracorporeal membrane oxygenation use in poisoning: a narrative review with clinical recommendations // Clin Toxicol (Phila). – 2021. – Vol. 59, № 10. – P. 877–887. https://doi.org/10.1080/15563650.2021.1945082.
47. Yu B., Ichinose F., Bloch D. B. et al. Inhaled nitric oxide // Br J Pharmacol. – 2019. – Vol. 176, № 2. – P. 246–255. https://doi.org/10.1111/bph.14512.
48. Wieruszewski P. M., Ortoleva J. P., Cormican D. S. et al. Extracorporeal Membrane Oxygenation in Acute Respiratory Failure // Pulm Ther. – 2023. – Vol. 9, № 1. – P. 109–126. https://doi.org/10.1007/s41030-023-00214-2.
Review
For citations:
Mikaelian K.A., Petrova M.V., Filimonova E.V., Zhakova Zh.V. Veno-venous extracorporeal membrane oxygenation in the treatment of severe respiratory failure (literature review). Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2025;22(3):119-128. (In Russ.) https://doi.org/10.24884/2078-5658-2025-22-3-119-128
Email this article 