Pathophysiology of respiratory failure and physiology of gas exchange during ECMO
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REVIEW ARTICLE
Pathophysiology of respiratory failure and physiology of gas exchange during ECMO Suresh Manickavel 1 Received: 26 June 2020 / Revised: 20 August 2020 / Accepted: 24 August 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Lungs play a key role in sustaining cellular respiration by regulating the levels of oxygen and carbon dioxide in the blood. This is achieved by exchanging these gases between blood and ambient air across the alveolar capillary membrane by the process of diffusion. In the microstructure of the lung, gas exchange is compartmentalized and happens in millions of microscopic alveolar units. In situations of lung injury, this structural complexity is disrupted resulting in impaired gas exchange. Depending on the severity and the type of lung injury, different aspects of pulmonary physiology are affected. If the respiratory failure is refractory to ventilator support, extracorporeal membrane oxygenation (ECMO) can be utilized to support the gas exchange needs of the body. In ECMO, thin hollow fiber membranes made up of polymethylpentene act as blood-gas interface for diffusion. Decades of innovative engineering with membranes and their alignment with blood and gas flows has enabled modern oxygenators to achieve clinically and physiologically significant amount of gas exchange. Keywords ECMO physiology . Respiratory failure . ECMO gas exchange . ARDS . Pulmonary fibrosis
Introduction Extracorporeal life support devices have revolutionized the management of diseases with life-threatening organ failure. Extracorporeal membrane oxygenation (ECMO) is a device to support blood circulation and maintain gas exchange in patients with severe cardiorespiratory failure. Such patients have a high mortality risk due to the underlying disease and the organ support with ECMO can act as a bridge to either recovery or organ transplantation. Advances in material science have produced biocompatible membranes with properties conducive to achieving a significant amount of gas exchange. Conceptual understanding of the process of gas exchange across an artificial membrane requires a thorough knowledge of the physical process of molecular diffusion, lung microstructure, and the physiology of air flow, blood flow, and its matching in the lung.
* Suresh Manickavel [email protected] 1
Miami Transplant Institute, University of Miami, 1801 NW 9th Ave, Miami, FL 33136, USA
Pulmonary gas exchange—relevant anatomy and physiology Cellular respiration is a fundamental process of life. In human physiology, it involves oxidation of macromolecules using oxygen, releasing carbon dioxide and water as end products. The energy released in this redox reaction is systematically trapped in high-energy bonds of adenosine triphosphate (ATP). This molecule subsequently powers all metabolic processes needed for maintenance of life. Lungs play a key role in sustaining cellular respiration by regulating the levels of oxygen and carbon dioxide in the blood. This is performed by exchanging gases be
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