Rising Above the Limits of Critical Care ECMO: A Narrative Review

Abstract

Extracorporeal membrane oxygenation (ECMO), an advanced life support method, was developed to treat severe cardiac and pulmonary failure in critically ill patients. ECMO was previously used to treat ARDS, cardiogenic shock, and after heart or lung transplant. It has since become a versatile therapeutic and surgical tool. When conventional methods fail, this technique works well for high-risk procedures such as tracheal resections, ventricular tachycardia ablations, and complicated percutaneous coronary interventions. These uses demonstrate ECMO's ability to oxygenate and stabilize the hemodynamics in challenging clinical circumstances. Clinical studies report survival rates exceeding 60% in ECMO-assisted thoracic surgeries, underscoring its efficacy in these settings. Recent advancements, such as portable ECMO systems and artificial intelligence-driven management tools, have further enhanced the safety and effectiveness of ECMO, enabling its use in diverse clinical environments. However, challenges remain, particularly in patient selection, resource allocation, and addressing ethical dilemmas. The integration of standardized protocols and technological innovations has mitigated complications such as vascular injury and infection, contributing to improved patient outcomes. This review examines ECMO applications and integration into multidisciplinary care, its configurations, and its growing role outside the intensive care unit in elective thoracic and cardiac surgery, trauma, and non-cardiac high-risk procedures.

Keywords: ECMO; cardiac surgery; critical care; perioperative medicine; respiratory failure.

Figure 1

Typical ECMO cannulation sequence and scenario during ECPR.

Figure 2

VV ECMO circuit schematics: deoxygenated blood is withdrawn from the venous circulation, oxygenated (Oxy) and pushed via the pump into the right atrium (RA). RV: right ventricle, LA: left atrium, LV: left ventricle.

Figure 3

VA ECMO circuit schematics: deoxygenated blood is withdrawn from the venous circulation, oxygenated (Oxy) and pushed via the pump into the systemic circulation bypassing the native lungs and heart. RA: right atrium, RV: right ventricle, LA: left atrium, LV: left ventricle.