What is Extracorporeal Membrane Oxygenation (ECMO)?

From the Guidelines

ECMO, or Extracorporeal Membrane Oxygenation, is a life support technique that temporarily takes over the function of the heart and lungs in critically ill patients, as described in the most recent study published in 2024 1.

Overview of ECMO

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.

• ECMO is typically used when conventional life support measures like mechanical ventilation are insufficient.
• There are two main types: veno-arterial (VA) ECMO, which supports both heart and lung function, and veno-venous (VV) ECMO, which supports only lung function.
• ECMO is used in severe respiratory failure (like ARDS or severe pneumonia), cardiac failure, or as a bridge to transplantation.

Implementation and Risks

• It requires specialized equipment, trained personnel, and is usually performed in intensive care units.
• While ECMO can be lifesaving, it carries risks including bleeding, infection, blood clots, and vascular complications, as highlighted in a study published in 2024 1.
• The duration of ECMO support varies from days to weeks depending on the patient's condition and recovery.

Clinical Applications

• ECMO has been used in various clinical settings, including cardiac arrest, as discussed in a study published in 2023 1.
• The use of ECMO in cardiac arrest has been supported by observational studies and randomized clinical trials, as mentioned in a study published in 2024 1.
• The American Heart Association has provided guidelines for the use of ECMO in adult advanced cardiovascular life support, including the initiation of cardiopulmonary bypass during resuscitation, as outlined in a study published in 2024 1.

From the Research

Definition and Purpose of Extracorporeal Membrane Oxygenation (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 cardiorespiratory failure, including those with hypoxia who would not have survived with conventional treatment 3.
• The technique involves draining desaturated blood from the patient, oxygenating it, and pumping it back to a major vein or artery, thus supporting heart and lung function 4.

Types and Configurations of ECMO

• There are two main types of ECMO: venovenous (VV) ECMO, which provides respiratory support, and venoarterial (VA) ECMO, which provides cardiac and/or respiratory support 2, 5.
• The configuration of ECMO is variable, with several pump-driven and pump-free systems in use 2.

Indications and Contraindications for ECMO

• ECMO is indicated for patients with severe respiratory failure, including those with acute respiratory distress syndrome (ARDS), and for those with cardiac failure or arrest 2, 3, 5.
• Patient selection for ECMO relies on the integration of physiological variables with an assessment of reversibility of the underlying condition or suitability for transplantation 3.
• Contraindications for ECMO include patients with irreversible brain damage, severe bleeding, or other conditions that make ECMO ineffective or unsafe 5.

Complications and Risks Associated with 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.
• Clinical complications of ECMO include bleeding, infection, and organ dysfunction 5.

Outcomes and Efficacy of ECMO

• The efficacy of ECMO in improving survival and outcomes for adults with respiratory failure remains uncertain, with low to moderate quality evidence available 2.
• However, ECMO has been shown to be effective in supporting patients with severe cardiorespiratory failure, with survival rates ranging from 63% to 81% in different age groups 4.
• Recent improvements in technology and patient management have led to constant improvement in patient outcomes, especially in centers with high caseload volumes and careful patient selection 6.