Membranoksygenering

Membranoksygenering is a form of extracorporeal life support in which blood is circulated outside the body through a circuit that includes a membrane oxygenator for gas exchange. Blood is pumped through the circuit, where carbon dioxide is removed and oxygen is added, before the blood is returned to the patient. The process is typically managed in specialized intensive care settings.

There are two main configurations: venovenous membranoksygenering (VV) for lung support only, and venoarterial membranoksygenering (VA) for combined heart and lung support. Cannulation usually involves large-bore veins and arteries, commonly the internal jugular and femoral vessels, with arterial return in VA setups. A pump and an oxygenator with a semi-permeable membrane facilitate gas exchange. Anticoagulation, usually with heparin, is commonly required to prevent circuit clotting, monitored by tests such as ACT or anti-Xa. The duration of membranoksygenering varies, often spanning days to weeks, depending on recovery and the underlying condition.

Indications include severe, reversible respiratory failure such as acute respiratory distress syndrome, neonatal or pediatric respiratory failure, and cardiogenic shock or cardiac arrest with a treatable etiology. Membranoksygenering is not a cure and is used when conventional therapies fail or are insufficient. Patient selection, timing, and center expertise strongly influence outcomes.

Risks and complications include bleeding due to anticoagulation, thrombosis, infection, hemolysis, limb ischemia, and neurological injury. Mortality and functional outcomes vary by indication and patient factors. Care is typically centralized in specialized centers with multidisciplinary teams, and data are collected in registries to inform clinical practice.