Recent advances in extracorporeal lung support systems

The treatment of severe acut lung failure includes artificial ventilation with a lung protective concept, but in situations of life-threatening respiratory failure with persistent hypoxia/hypercapnia, the technique of extracorporeal lung assist has been employed. A veno-venous pump-driven extracorporeal membrane oxygenation (ECMO) is established in specialized centres requiring extended equipment with technical and support staff and costs for patients with severe ARDS , while the use of a new technique of a pumpless interventional lung assist (iLA) using a femoral arterio-venous pressure gradient as the driving force for blood flow through a gas exchange membrane has been reported in patients suffering from severe lung failure due to trauma, sepsis or brain injury. ILA is a new and promising strategy for extracorporeal lung support allowing a de-escalation of injurious ventilation, but it contains a risk for potentially severe complications. For assessment of clinical perspectives and precise indications for both strategies aimed at restoring adequate gas exchange and supporting lung protective ventilation will be elucidated by multicentric prospective randomized clinical studies in the near future.