Mechanical ventilation primarily supports respiratory function, while an IABP provides temporary circulatory support in cardiac failure. ECMO, on the other hand, offers comprehensive cardiopulmonary support and can be tailored to provide respiratory, cardiac, or combined support in critically ill patients with severe respiratory or cardiac failure. Each modality has specific indications, limitations, and risks, and the choice of therapy depends on the underlying pathology, patient characteristics, and available resources.
Firstly, the LVAD (Left Ventricular Assist Device) should be included in this discussion, because it can function as an artificial heart for years if necessary. Secondly, all these modalities are expensive and dangerous, and should be avoided in favor of safer and simpler measures.
The discovery of the mammalian stress mechanism (MSM), which functions continuously to repair tissues and regulate organs, provides a theoretical explanation for all forms critical illnesses, including eclampsia, ARDS, SIRS, SARS, MERS, COVID, MOFS, Sepsis, pneumonia, severe burn syndrome, Surgical Stress Syndrome, and major trauma.1 All of these “syndromes” are essentially the same because they are all caused by combinations of severe, unrelenting environmental stresses that induce MSM hyperactivity via combinations of nervous hyperactivity and tissue disruption. MSM hyperactivity wastes its substrates and produces excessive and defective versions of its products. This explains all the confusing manifestations of disease. The fundamental objective of medical treatment is to control and reduce stress mechanism hyperactivity to restore effective tissue perfusion and oxygenation and optimize organ function.
MSM hyperactivity can best be controlled as follows:
1. Elective endotracheal intubation to prevent aspiration and airway obstruction, enable monitoring and measurement of inhaled gas mixtures, and isolate medical workers from contagion.
2. ½ MAC general anesthesia with Isoforane to extinguish consciousness and eliminate fear and anxiety that exaggerates harmful sympathetic nervous activity. Propofol should be avoided on account of its dangerous toxicity. Anesthetic inhalation agent concentrations can be maintained at constant low levels that minimize toxicity, and they can be eliminated regardless of organ function.
3. Generous treatment with modern synthetic narcotics to maintain exhaled CO2 concentrations in the range of 50-100 torr to minimize microvascular flow resistance, optimize cardiac output, sustain respiratory drive, maximize tissue oxygenation, and control nociception that exaggerates harmful sympathetic nervous activity.
4. Antibiotics as needed to control bacterial infestation. The potency and penetration of antibiotics will be optimized by measures 1-3.
5. Spontaneous respiration is always preferable, but if mechanical ventilation becomes necessary care should be taken to avoid excessive pressures and volumes that cause “stretch injury” to lung tissues.
6. IV fluids should be minimized to avoid “wet lung” that undermines pulmonary gas exchange.
7. Measures 1-6 should be maintained even if IABP, LVAD, or ECMO is deemed necessary. ECMO is especially dangerous because it damages red cells and releases their toxic contents into systemic circulation.
1 Coleman, L. S. 50 Years Lost in Medical Advance: The Discovery of Hans Selye’s Stress Mechanism. (The American Institute of Stress Press, 2021).