Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Oct 14;31(3):410-424.
doi: 10.5935/0103-507X.20190063. eCollection 2019.

Extracorporeal membrane oxygenation: a literature review

[Article in Portuguese, English]
Renato Carneiro de Freitas Chaves  1   2 , Roberto Rabello Filho  1 , Karina Tavares Timenetsky  1 , Fabio Tanzillo Moreira  1   3 , Luiz Carlos da Silva Vilanova  1 , Bruno de Arruda Bravim  1 , Ary Serpa Neto  1 , Thiago Domingos Corrêa  1   3
Affiliations
Review

Extracorporeal membrane oxygenation: a literature review

[Article in Portuguese, English]
Renato Carneiro de Freitas Chaves et al. Rev Bras Ter Intensiva. .

Abstract
in English, Portuguese

Extracorporeal membrane oxygenation is a modality of extracorporeal life support that allows for temporary support in pulmonary and/or cardiac failure refractory to conventional therapy. Since the first descriptions of extracorporeal membrane oxygenation, significant improvements have occurred in the device and the management of patients and, consequently, in the outcomes of critically ill patients during extracorporeal membrane oxygenation. Many important studies about the use of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome refractory to conventional clinical support, under in-hospital cardiac arrest and with cardiogenic refractory shock have been published in recent years. The objective of this literature review is to present the theoretical and practical aspects of extracorporeal membrane oxygenation support for respiratory and/or cardiac functions in critically ill patients.

A oxigenação por membrana extracorpórea é uma modalidade de suporte de vida extracorpóreo que possibilita suporte temporário à falência da função pulmonar e/ou cardíaca, refratária ao tratamento clínico convencional. Desde as primeiras descrições da oxigenação por membrana extracorpórea, melhorias significativas ocorreram no dispositivo, no manejo do paciente e, consequentemente, nos desfechos dos pacientes em oxigenação por membrana extracorpórea. Diversos estudos importantes sobre a utilização de oxigenação por membrana extracorpórea em pacientes com síndrome do desconforto respiratório agudo refratária ao suporte clínico convencional, em parada cardíaca intra-hospitalar e choque cardiogênico refratário foram publicados nos últimos anos. Dessa forma, o objetivo desta revisão é apresentar conceitos teóricos e práticos sobre a utilização da oxigenação por membrana extracorpórea em situações de falência pulmonar e/ou cardíaca refratária ao manejo clínico convencional em pacientes críticos.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Diagram of the standard extracorporeal membrane oxygenation circuit. The venous blood is removed from the patient through a drainage cannula and is pumped (blood pump) to the oxygenator. After passing through the oxygenator, where the oxygenation membrane is, the blood is returned to the patient through an artery (venoarterial extracorporeal membrane oxygenation) or a vein (venovenous extracorporeal membrane oxygenation). There are access routes located along the extracorporeal membrane oxygenation circuit (venous and arterial access points) for infusion of medications and fluids and collection of laboratory tests, in addition to pressure sensors (pre-membrane and post-membrane) and flow sensors.
Figure 2
Figure 2
Oxygenator and oxygenation membrane. Once the cannulation of the patient is completed and the extracorporeal membrane oxygenation circuit is established, the patient's blood is pumped to the oxygenator. The oxygenator consists of a container with two chambers separated by a semipermeable membrane - the oxygenation membrane. While the patient's blood flows through one chamber, a gas mixture, called fresh gas flow, flows through the other. It is through the oxygenation membrane that gas diffusion occurs between the patient's blood and the fresh gas flow, allowing for the oxygenation of venous blood and the removal of carbon dioxide. The composition of the gas mixture in the fresh gas flow is determined by adjusting the inspired fraction of oxygen in the gas mixer. O2 - oxygen; CO2 - carbon dioxide.
Figure 3
Figure 3
Diagram of a venovenous extracorporeal membrane oxygenation circuit. Blood from the inferior vena cava is drained through a cannula in the right femoral vein. Then, the blood passes through the propulsion pump and the oxygenation membrane, returning to the venous system of the patient through the right internal jugular vein.
Figure 4
Figure 4
Diagram of a peripheral venoarterial extracorporeal membrane oxygenation circuit. The blood from the inferior vena cava is drained through a cannula in the right femoral vein. Then, the blood passes through the blood pump and the oxygenation membrane, returning to the arterial system of the patient through the left femoral artery.
See this image and copyright information in PMC

References

    1. Combes A, Hajage D, Capellier G, Demoule A, Lavoue´ S, Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, Maury E, Levy B, Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A, EOLIA Trial Group. REVA. ECMONet Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378(21):1965–1975. - PubMed
    1. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D, CESAR trialcollaboration Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351–1363. Erratum in Lancet. 2009;374(9698):1330. - PubMed
    1. Morris AH, Wallace CJ, Menlove RL, Clemmer TP, Orme Jr JF, Weaver LK, et al. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Pt 1Am J Respir Crit Care Med. 1994;149(2):295–305. Erratum in Am J Respir Crit Care Med. 1994;149(3 Pt 1):838. - PubMed
    1. Zapol WM, Snider MT, Hill JD, Fallat RJ, Bartlett RH, Edmunds LH, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979;242(20):2193–2196. - PubMed
    1. Dangers L, Bréchot N, Schmidt M, Lebreton G, Hékimian G, Nieszkowska A, et al. Extracorporeal Membrane oxygenation for acute decompensated heart failure. Crit Care Med. 2017;45(8):1359–1366. - PubMed

MeSH terms