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Extracorporeal Life Support FREE TO VIEW

Mark Crowley
Chest. 2003;124(6):2410-2411. doi:10.1378/chest.124.6.2410-a
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Published online


By Dan M. Meyer and Michael Jessen. Georgetown, TX: Landes Biosciences, 2001; 136 pp; $45.00

Extracorporeal membrane oxygenation (ECMO) is a highly technical, invasive therapy that is essentially modified cardiopulmonary bypass used to support some patients with acute cardiopulmonary failure. The management of ECMO patients is particularly challenging since ECMO is used only after less risky “conventional” critical care therapies have failed, and because the physiology of an ECMO patient represents a unique mixture of the patient’s own physiology and the physiology of the bypass circuit.

Extracorporeal Life Support is a handbook designed to provide quick reference information for nurses, ECMO specialists, respiratory therapists, perfusionists, and physicians using extracorporeal support. The book is written in an outline format with many tables and figures. The majority of the information is about ECMO, particularly neonatal ECMO, and is described in the context of the spectrum of extracorporeal support and new alternative therapies for cardiopulmonary failure. The text includes brief descriptions of the history of cardiopulmonary bypass and ECMO, and then goes on to present in-depth descriptions of the principles of bypass physiology, including oxygen delivery, gas exchange, and hemodynamic support. In the chapter on the mechanics of ECMO, different types of pumps, oxygenators, and types of ECMO (ie, venovenous and venoarterial) are described. The text includes management guidelines on how to care for the ECMO patient, covering such issues as monitoring, anticoagulation, fluids and electrolytes, nutrition, and sedation. The use of ECMO for different indications (ie, neonatal, pediatric, and adult respiratory failure, and cardiac support) also is covered, and there is a chapter on troubleshooting problems that commonly develop in the ECMO patient. The last two chapters discuss the outcomes of ECMO when it is used in neonatal, pediatric, and adult populations, and newer or emerging therapies for cardiopulmonary failure such as inhaled nitric oxide, high-frequency ventilation, surfactant, intravenous oxygenation and carbon dioxide removal device (IVOX), and perfluorocarbons/liquid ventilation.

Overall, I found this book to be well-written and concise. The most valuable chapters are those on mechanics, clinical management, monitoring, and troubleshooting, which give specific and practical information for managing an ECMO patient. The tables are particularly helpful as they contain many of the details necessary for managing the care of an ECMO patient. For example, they outline the differences in management principles between venoarterial and venovenous ECMO, specify important information on choice of cannula size, circuit characteristics, and limits of pump and gas flow, and summarize hemodynamic and oxygenation monitoring of the ECMO patient. The troubleshooting chapter is extremely helpful, as often the evaluation of an ECMO problem needs to be done quickly and is facilitated by the telegraphic format this handbook employs. The last two chapters, covering the outcomes experienced in the care of ECMO patients and newer cutting-edge therapies for cardiopulmonary failure, are excellent literature-based discussions of these issues.

In summary, Extracorporeal Life Support is a valuable text that clearly and concisely presents crucial information for the management of ECMO and other types of extracorporeal support. Encompassing practical information as well as theoretical principles, it is a useful tool in the care of these patients.




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