Extracorporeal membrane oxygenation (ECMO) in adults
- 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. Extensive information about indications, complications, and outcome is available from the web site of the Extracorporeal Life Support Organization .
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 [2-15]. After two poorly designed randomized trials of ECMO in the 1970s, all nine subsequent controlled trials show a significant survival benefit to ECMO compared with conventional care in neonates (five trials), children (one trial), and adults (three trials) . ECMO is the only life support system in acute fatal illness which has been studied in controlled trials compared with conventional care.
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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