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Review
. 2023 Apr;39(2):255-275.
doi: 10.1016/j.ccc.2022.09.003. Epub 2022 Dec 22.

Extracorporeal Membrane Oxygenation Then and Now; Broadening Indications and Availability

Blythe E Pollack  1 , Roxanne Kirsch  2 , Rachel Chapman  3 , Robert Hyslop  4 , Graeme MacLaren  5 , Ryan P Barbaro  6
Affiliations
Review

Extracorporeal Membrane Oxygenation Then and Now; Broadening Indications and Availability

Blythe E Pollack et al. Crit Care Clin. 2023 Apr.

Abstract

Extracorporeal membrane oxygenation (ECMO) is a life support technology provided to children to support respiratory failure, cardiac failure, or cardiopulmonary resuscitation after failure of conventional management. Over the decades, ECMO has expanded in use, advanced in technology, shifted from experimental to a standard of care, and evidence supporting its use has increased. The expanded ECMO indications and medical complexity of children have also necessitated focused studies in the ethical domain such as decisional authority, resource allocation, and equitable access.

Keywords: Cardiac failure; Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO); Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation (ECPR); Neonatal; Pediatric acute respiratory distress syndrome (PARDS).

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Figures

Figure 1:
Figure 1:
Venoarterial (VA), venovenous (VV), and venopulmonary (VP) ECMO. (Panel A) Venoarterial ECMO using two single lumen catheters, one placed in the RIJV draining form the right atrium and one placed in the right carotid artery, reinfusing just above the aortic arch. (Panel B) Venovenous ECMO using dual lumen catheter placed in the right internal jugular vein (RIJV), draining from the superior vena cava and right atrium, reinfusing into the right atrium. (Panel C) Venopulmonary ECMO using a dual lumen catheter placed in the RIJV, draining from the right atrium and reinfusing into the main pulmonary artery. (Panel D) Venoarterial ECMO using two single lumen catheters one placed in the right femoral vein, draining form the inferior vena cava and one placed in the right femoral artery, reinfusing into the aorta. In this picture also, a left atrial drain placed in the left formal vein and traversing the right atrium into the left atrium across a septostomy.
Figure 1:
Figure 1:
Venoarterial (VA), venovenous (VV), and venopulmonary (VP) ECMO. (Panel A) Venoarterial ECMO using two single lumen catheters, one placed in the RIJV draining form the right atrium and one placed in the right carotid artery, reinfusing just above the aortic arch. (Panel B) Venovenous ECMO using dual lumen catheter placed in the right internal jugular vein (RIJV), draining from the superior vena cava and right atrium, reinfusing into the right atrium. (Panel C) Venopulmonary ECMO using a dual lumen catheter placed in the RIJV, draining from the right atrium and reinfusing into the main pulmonary artery. (Panel D) Venoarterial ECMO using two single lumen catheters one placed in the right femoral vein, draining form the inferior vena cava and one placed in the right femoral artery, reinfusing into the aorta. In this picture also, a left atrial drain placed in the left formal vein and traversing the right atrium into the left atrium across a septostomy.
Figure 1:
Figure 1:
Venoarterial (VA), venovenous (VV), and venopulmonary (VP) ECMO. (Panel A) Venoarterial ECMO using two single lumen catheters, one placed in the RIJV draining form the right atrium and one placed in the right carotid artery, reinfusing just above the aortic arch. (Panel B) Venovenous ECMO using dual lumen catheter placed in the right internal jugular vein (RIJV), draining from the superior vena cava and right atrium, reinfusing into the right atrium. (Panel C) Venopulmonary ECMO using a dual lumen catheter placed in the RIJV, draining from the right atrium and reinfusing into the main pulmonary artery. (Panel D) Venoarterial ECMO using two single lumen catheters one placed in the right femoral vein, draining form the inferior vena cava and one placed in the right femoral artery, reinfusing into the aorta. In this picture also, a left atrial drain placed in the left formal vein and traversing the right atrium into the left atrium across a septostomy.
Figure 1:
Figure 1:
Venoarterial (VA), venovenous (VV), and venopulmonary (VP) ECMO. (Panel A) Venoarterial ECMO using two single lumen catheters, one placed in the RIJV draining form the right atrium and one placed in the right carotid artery, reinfusing just above the aortic arch. (Panel B) Venovenous ECMO using dual lumen catheter placed in the right internal jugular vein (RIJV), draining from the superior vena cava and right atrium, reinfusing into the right atrium. (Panel C) Venopulmonary ECMO using a dual lumen catheter placed in the RIJV, draining from the right atrium and reinfusing into the main pulmonary artery. (Panel D) Venoarterial ECMO using two single lumen catheters one placed in the right femoral vein, draining form the inferior vena cava and one placed in the right femoral artery, reinfusing into the aorta. In this picture also, a left atrial drain placed in the left formal vein and traversing the right atrium into the left atrium across a septostomy.
Figure 2:
Figure 2:
Total ECMO runs from 1987–2021, including the adult, pediatric, and neonatal population. Data from Extracorporeal Life Support Organizaiton (ELSO) Registry. Extracorporal membrane oxygenation (ECMO); Neonatal = 0 – 28 days; Pediatric = 29 days – 17 years old; Adult ≥ 18 years old.
Figure 3:
Figure 3:
Neonatal respiratory ECMO survival from 1987 through 2021. Data from Extracorporeal Life Support Organizaiton (ELSO) Registry. Extracorporal membrane oxygenation (ECMO), Neonatal = 0 – 28 days.
Figure 4:
Figure 4:
Pediatric cardiac ECMO survival 1987 through 2021. Data from Extracorporal membrane oxygenation (ECMO), Neonatal = 0 – 28 days; Pediatric = 29 days – 17 years old.
Figure 5:
Figure 5:
Total neonatal and pediatric cases of respiratory ECMO, cardiac ECMO, and ECPR from 1987–2021. Data from Extracorporeal Life Support Organizaiton (ELSO) Registry. Extracorporeal membrane oxygenation (ECMO), ECMO to support cardiopulmonary resuscitation (ECPR); Neonatal = 0 – 28 days old; Pediatric = 29 days – 17 years old.
See this image and copyright information in PMC

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