Emerging treatments
Extracorporeal membrane oxygenation
Extracorporeal membrane oxygenation (ECMO) may play a role in management of cardiogenic shock by providing mechanical pulmonary and circulatory support when the shock state is refractory to medical and surgical therapy.[119][120][121] ECMO may also be useful in sepsis-induced severe acute respiratory distress syndrome when conventional mechanical ventilation fails, in centers where the expertise and infrastructure is in place to support its use.[2]
Polymyxin B hemoperfusion
Meta-analysis suggests that polymyxin B hemoperfusion, a technique that removes circulating endotoxins extracorporeally using a polymyxin B-adsorbing cartridge, may reduce mortality in patients with severe sepsis and septic shock in specific disease severity subgroups.[122] However, in one subsequent randomized controlled trial, targeted polymyxin B hemoperfusion did not reduce 28-day mortality in patients with septic shock (high acuity, and at higher risk of death than patients enrolled in prior trials) and elevated endotoxin level.[123] The Surviving Sepsis Campaign guidelines advise against using polymyxin B in patients with sepsis or septic shock on the basis of several factors. These include uncertainty with regard to any beneficial effect, the potential frequency of undesirable side effects, significant expense, and resource intensiveness.[2]
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