ECMO in the awake/extubated patient

Abstract

Why not to treat lung failure by temporary replacement with an artificial lung? With the latest technical developments, an awake, extubated patient supported by ECMO is no more a dream. At least for selected applications like bridging to lung transplantation, the advantage of avoiding invasive mechanical ventilation and heavy sedation seems to overcome the risks connected with ECMO. Awake ECMO has been applied mostly as venovenous bypass but also as arteriovenous, venoarterial, or pulmonary bypass. Awake ECMO is usually backed by a noninvasive ventilatory support, at least in the form of continuous positive airway pressure. ECMO in awake patients poses particular problems, like appropriate setting of sweep gas flow to modulate patient’s work of breathing or setting of blood temperature to stop shivering in septic patients. The psychological stress of the patient being aware that his/her own life depends on ECMO is another problem that must not be forgotten.