[ECMO and cardiopulmonary support]

Abstract

ECMO (extracorporeal membrane oxygenation) may be viewed as a prolonged cardiopulmonary bypass allowing for a prolonged cardio-respiratory support. Since its introduction in the 60's, its indication has expanded from acute respiratory failure to acute cardiac failure refractory to conventional treatments. The target group involves mainly those patients presenting with a cardiogenic shock following cardiac surgery or acute myocardial infarction. The advantages of this form of circulatory support, when compared with long-term ventricular assist devices, are its less invasive aspect, its ease of implantation and its reduced cost. However, its main limitation lies in its limited duration of 7 to 10 days, in particular because of hemorrhage complications. Currently, ECMO provides a temporary hemodynamical stability in order to perform an invasive cardiac treatment (coronary bypass or percutaneous dilatation), or to assess the eligibility of the patient for a long-term ventricular assist device, which will enable to wait for the availability of an allograft. The latter scenario is crucial nowadays because of the severe lack of organ donors, which is the leading cause of death among patients waiting for a heart transplant.