Circulations extracorporelles d'assistance respiratoire en réanimation chez l'adulte

Since its first description, the care of the acute respiratory distress syndrome has considerably changed. While pathophysiology remain a subject to debate and intensive research, the use of high tidal volume and airway pressure has been demonstrated to be harmful. Extracorporeal membrane oxygenation (ECMO) technics are able to remove carbon dioxide allowing gentle ventilation. According to the technic used, oxygenation and hemodynamic stability may be achieved. Several case reports have been published in the past and recent literature, however two prospective randomised trials failed to demonstrate an impact on survival rate. Heavily discussed on technics, experience and management of the teams involved in these study and according to new developments and concepts, several studies are waiting publication or under way. Extracorporeal membrane oxygenation is indicated as part of global strategy with dedicated and trained team to avoid complications and after referral if necessary.