From the Guidelines
Extracorporeal membrane oxygenation (ECMO) is a life-saving technique that provides cardiac and respiratory support to patients whose heart and lungs are severely damaged and unable to function adequately, as described in the most recent study 1.
Overview of ECMO
ECMO works by removing blood from the patient's body, oxygenating it through an artificial lung (membrane oxygenator), and then returning it to the patient's circulation. There are two main types:
- Veno-arterial (VA) ECMO, which provides both cardiac and respiratory support
- Veno-venous (VV) ECMO, which provides only respiratory support, as noted in 1 and also discussed in an earlier study 1.
Clinical Applications
ECMO is typically used in critical situations such as:
- Severe acute respiratory distress syndrome (ARDS)
- Cardiogenic shock
- Cardiac arrest
- As a bridge to heart or lung transplantation, as supported by the findings in 1.
Procedure and Complications
The procedure requires anticoagulation, typically with unfractionated heparin, to prevent clot formation in the ECMO circuit, as recommended in 1. Potential complications include:
- Bleeding
- Thrombosis
- Infection
- Vascular damage
Patient Selection and Care
ECMO is not a definitive treatment but rather a temporary support measure that allows time for the patient's organs to recover or for other interventions to be implemented. The duration of ECMO support varies widely depending on the clinical situation, ranging from days to weeks. Patient selection is crucial, as ECMO carries significant risks and requires specialized care in centers with experienced ECMO teams, as emphasized in 1.
From the Research
Definition and Purpose of ECMO
- Extracorporeal Membrane Oxygenation (ECMO) is a technique used to support patients with severe acute respiratory or circulatory failure 2, 3, 4.
- It enables effective blood oxygenation and carbon dioxide removal for several weeks, allowing the lungs or heart to recover 2.
- ECMO can be used in two main modes: Veno-Venous (V-V ECMO) for respiratory failure and Veno-Arterial (V-A ECMO) for circulatory failure 2, 5.
Types of ECMO
- Veno-Venous ECMO (V-V ECMO) is used to support patients with severe respiratory failure, such as those with Acute Respiratory Distress Syndrome (ARDS) 2, 3.
- Veno-Arterial ECMO (V-A ECMO) is used to support patients with circulatory failure, such as those with cardiac arrest or severe heart failure 2, 5.
- Veno-Arteriovenous ECMO (V-AV ECMO) is a hybrid mode that combines the benefits of V-V ECMO and V-A ECMO, and is used in certain cases where both respiratory and circulatory support are needed 5.
Indications and Patient Selection
- ECMO is typically used in patients with severe respiratory or circulatory failure who have not responded to conventional treatment 2, 3.
- Patient selection for ECMO is critical, and is based on factors such as the severity of illness, the potential for recovery, and the presence of contraindications 3.
- The decision to initiate ECMO is often made on a case-by-case basis, taking into account the individual patient's circumstances and the availability of resources 3.
Clinical Applications and Outcomes
- ECMO has been shown to improve outcomes in patients with severe ARDS, by allowing for lung-protective ventilation and reducing the risk of ventilator-induced lung injury 2, 3.
- ECMO can also be used to support patients with cardiopulmonary failure, such as those with cardiac arrest or severe heart failure, and can improve outcomes in these patients 5, 4.
- The use of ECMO requires careful monitoring and management, including anticoagulation therapy and close attention to hemodynamic and respiratory parameters 6, 5.