Pumpless arteriovenous extracorporeal lung assist: what is its role?

Extracorporeal lung assist (ECLA) is an established treatment of severe pul monary failure, Since extracorporeal perfusion is applied in a long-term fa shion in this setting, the negative impact on brood compounds is of tremend ous importance. Pumpless arteriovenous ECLA (aV-ECLA) is an alternatively introduced techni que that focuses on reduced blood traumatization. However, due to determini ng technical and physiological aspects, its clinical application is limited to a highly selected group of patients. Membrane oxygenators with minimal pressure gradients, as well as stable patients' haemodynamics providing a s ufficient cardiac output, are the most important prerequisites. With respec t to recent reports, characteristic features of aV-ECLA, with special empha sis on its physiological background, are reviewed. Accordingly, reasonable indications for its beneficial use are discussed. It is concluded that aV-ECLA is a feasible technique when its limitations a re accepted. For adequate clinical use, more data concerning indications, a s well as time- and technique-related directions are required.