From the Guidelines
ECMO, or Extracorporeal Membrane Oxygenation, is a life support technique that temporarily takes over the function of the heart and lungs when these organs are severely damaged or failing, as described in the most recent study 1. It works by removing blood from the patient's body, passing it through an artificial lung (oxygenator) that adds oxygen and removes carbon dioxide, and then returning the blood to the patient's circulation. There are two main types:
- veno-arterial (VA) ECMO, which supports both heart and lung function
- veno-venous (VV) ECMO, which supports only lung function. ECMO is typically used in critical situations such as severe respiratory failure (like ARDS), cardiac failure, or as a bridge to transplantation. The procedure requires specialized equipment and a team of trained healthcare professionals, including perfusionists, intensive care specialists, and surgeons. While ECMO can be lifesaving, it carries risks including bleeding, infection, blood clots, and vascular complications, as highlighted in a recent study 1. It's generally used when conventional treatments like mechanical ventilation have failed and is considered a temporary support measure until the patient's organs recover or another intervention becomes available. The use of ECMO has been supported by recent guidelines, including the 2023 American Heart Association focused update on adult advanced cardiovascular life support 1. Overall, ECMO is a complex and highly specialized treatment that requires careful consideration and management to minimize risks and optimize outcomes, as emphasized in a comprehensive review 1.
From the Research
Definition and Purpose of ECMO
- Extracorporeal Membrane Oxygenation (ECMO) is a form of life support that targets the heart and lungs, providing non-pulmonary gas exchange and systemic circulation 2.
- ECMO is used to support patients with severe respiratory failure, cardiac failure, or refractory cardiac arrest, giving them a chance to survive when these organs are inefficient 3.
- The primary goal of ECMO is to augment oxygenation, ventilation, and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient 4.
Types and Configurations of ECMO
- There are two main types of ECMO: venovenous (VV) and venoarterial (VA) ECMO, which differ in their configuration and the type of support they provide 2, 3.
- VV ECMO is used as a respiratory support, while VA ECMO is used as a cardiac and/or respiratory support 3.
- The configuration of ECMO is variable, and several pump-driven and pump-free systems are in use 2.
Indications and Contraindications for ECMO
- ECMO is indicated for patients with severe, life-threatening respiratory failure who have failed to respond to conventional therapies 3, 4.
- The Extracorporeal Life Support Organization (ELSO) Guidelines provide specific inclusion criteria for ECMO, including PaO2 / FiO2 < 80 for at least 3 hours or pH < 7.25 for at least 3 hours 3.
- ECMO is contraindicated in patients with certain conditions, such as irreversible brain damage or terminal illness 3.
Risks and Complications of ECMO
- ECMO is associated with several risks, including patient-related adverse events such as hemorrhage or extremity ischemia, and circuit-related adverse effects such as pump failure, oxygenator failure, and thrombus formation 2.
- Proper ECMO management requires advanced medical care to minimize the risk of complications 3.
Clinical Applications and Outcomes of ECMO
- ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy, with promising data for its use in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock 4.
- The survival rate for ECMO patients varies depending on the age group and underlying condition, with reported survival rates ranging from 63% to 81% 5.
- ECMO has become a routine therapy for newborns, children, and adults with various forms of cardiogenic shock, and its indications and situations continue to evolve 6.