Current status of extracorporeal life support (ECMO) for cardiopulmonary failure

Abstract

Extracorporeal life support with artificial heart and lung for cardiopulmonary failure is commonly called extracorporeal membrane oxygenation (ECMO). ECMO can provide partial or total support, is temporary, and requires systemic anticoagulation. ECMO controls gas exchange and perfusion, stabilizes the patient physiologically, decreases the risk of ongoing iatrogenic injury, and allows ample time for diagnosis, treatment, and recovery from the primary injury or disease. ECMO is used in a variety of clinical circumstances and the results depend on the primary indication. ECMO provides life support but is not a form of treatment. Survival ranges from 30% in extracorporeal cardiopulmonary resuscitation to 95% for neonatal meconium aspiration syndrome. The major limitations to widespread applications are the need for anticoagulation and bleeding complications. However, nowadays, the new devices allow only minor bleeding that is rarely a fatal complication. Research on non-thrombogenic surfaces holds the promise of prolonged extracorporeal circulation without anticoagulation and without bleeding. The next decade may bring routine application of ECMO to all advanced Intensive Care Units where patients with profound respiratory and cardiac failure are treated.