Extracorporeal life support: updates and controversies

Abstract

The use of Extracorporeal Life Support (ECLS) in children and adults has markedly increased during the past few years with over 4000 patients placed on ECLS every year in over 200 centers. This article focuses on updates to the physiology and mechanics of ECLS with use of magnetically levitated centrifugal pumps, hollow-fiber gas-exchange devices, and bi-caval dual-lumen catheters. We also explore controversies in management including indications, cannulation approaches, renal replacement, monitoring of anticoagulation, early ambulation, and termination of ECLS. Finally, we present changes in the systems that provide ECLS including the single-provider model and regionalization of care.

Keywords: Anticoagulation; Continuous renal replacement therapy (CRRT); Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO); Neonatal critical care; Pediatric critical care.