Extracorporeal membrane oxygenation (ECMO) in adults
- Jonathan Haft, MD
Jonathan Haft, MD
- Associate Professor of Cardiac Surgery and Anesthesia
- University of Michigan
- Robert Bartlett, MD
Robert Bartlett, MD
- Professor Emeritus
- University of Michigan Health Systems
Mechanical cardiopulmonary support is most often applied intraoperatively to facilitate cardiac surgery (ie, cardiopulmonary bypass). However, cardiopulmonary support can also be delivered in a more prolonged fashion in an intensive care unit, although it is less common.
Prolonged cardiopulmonary support is called extracorporeal membrane oxygenation (ECMO), extracorporeal life support, or extracorporeal lung assist. There are two types of ECMO – venoarterial (VA) and venovenous (VV). Both provide respiratory support, but only VA ECMO provides hemodynamic support.
The impact of ECMO on clinical outcomes as well as patient selection, technical aspects, and complications will be reviewed here. Only adult applications are discussed.
Survival — The survival of patients undergoing ECMO can be categorized according to the indication for the ECMO: severe acute respiratory failure or cardiac failure.
Acute respiratory failure — Multiple studies have evaluated the effect of ECMO on mortality in patients with severe acute respiratory failure [1-11]:
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- Thiele H, Sick P, Boudriot E, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 2005; 26:1276.
- Peek GJ, Killer HM, Reeves R, et al. Early experience with a polymethyl pentene oxygenator for adult extracorporeal life support. ASAIO J 2002; 48:480.
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- Khoshbin E, Roberts N, Harvey C, et al. Poly-methyl pentene oxygenators have improved gas exchange capability and reduced transfusion requirements in adult extracorporeal membrane oxygenation. ASAIO J 2005; 51:281.
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- - Acute respiratory failure
- - Cardiac failure
- PATIENT SELECTION
- Relative contraindications
- - Cannulation
- - Titration
- - Special considerations
- Weaning from ECMO
- Heparin-induced thrombocytopenia
- VA ECMO-specific complications
- SUMMARY AND RECOMMENDATIONS