ECMO-/ECLS

venous obstruction and may lead to arterial compression. Tissue swelling
initiates progressive cellular injury, edema formation, inadequate oxygen
delivery, anaerobic metabolism, and cell death.
There are three types of comparment syndrome (CS): primary,
secondary, and recurrent. Primary CS occurs when there is direct traumatic or
ischemic insult resulting in physical tissue destruction (crush injury) or vascular
injury. Secondary CS is thought to result from cytokine release and systemic
inflammatory response. Recurrent CS is due to a “second hit” phenomenon
following initial injury from primary or secondary CS.
Factors that modulate effects of elevated compartment pressures
include rapidity of onset, duration on intracompartmental hypertension,
compartmental perfusion pressure and rapidity of decompression.
Abdominal compartment syndrome (ACS) occurs when the pressure in
the abdominal cavity increases significantly to result in adverse physiologic
consequences and possible organ system failure. Normal intraabdominal
pressure is usually subatmospheric. Postoperatively, the pressure may
increase to 3-15mm Hg. Organ system dysfunction may be seen at 10-30 mm
Hg. At abdominal pressures greater than 30 mm Hg, there may be organ
dysfunction. At these pressures, anuria and ventilatory compromise may be
seen.
End organ manifestations may occur at pressures as low as 15 mm Hg.
In fact, some authors define ACS as intraabdominal pressure greater than 15
mmHg and one or more of the following problems: metabolic acidosis despite