Extracorporeal membrane oxygenation (ECMO), sometimes used interchangeably with extracorporeal life support, is a therapy that artificially supports pulmonary and/or cardiac organ systems. Venous blood is continuously withdrawn from a patient and passed across a membrane that can support both oxygenation and removal of carbon dioxide; blood is then reinfused back into the patient via venous or arterial access. A pump in the circuit can augment cardiac output, if necessary. Initial treatment with ECMO had discouraging outcomes, but recent experience with acute respiratory distress syndrome and the H1N1 influenza A pandemic in 2009 have led to a resurgence in popularity and additional research into this technique. At this time, treatment with ECMO is limited to highly specialized centers with well-trained practitioners. ECMO continues to be used primarily as a salvage technique in severe critical illness. This review will discuss the indications, complications, and types of ECMO. A guide to the clinical use of ECMO concludes the review.
LimMW. The history of extracorporeal oxygenators. Anaesthesia. 2006;61:984-995.
2.
HookeR. An account of an experiment made by Mr. Hooke, of preserving animals alive by blowing through their lungs with bellows. Phil Trans R Soc Lond. 1667;2:539-540.
3.
Randel-BakerL. History of thoracic anesthesia. In: MushinWW, ed. Thoracic Anesthesia. Philadelphia, PA: FA Davis; 1963:598-661.
4.
Le GalloisM. Experimences sur le principe de la vie. Paris, France: D’Hautel; 1812.
5.
HewittRLCreechOJr.History of the pump oxygenator. Arch Surg. 1966;93:680-696.
6.
HillJDO’BrienTGMurrayJJ. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med. 1972;286:629-634.
7.
ZapolWMSniderMTHillJD. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979;242:2193-2196.
8.
MorrisAHWallaceCJMenloveRL. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994;149(2 pt 1):295-305.
9.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301-1308.
10.
BrowerRGLankenPNMacIntyreN. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004;351:327-336.
11.
PeekGJMugfordMTiruvoipatiR; CESAR trial collaboration. 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;374:1351-1363.
12.
TerragniPPDel SorboLMasciaL. Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal. Anesthesiology. 2009;111:826-835.
BroganTVThiagarajanRRRycusPTBartlettRHBrattonSL. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med. 2009;35:2105-2114.
15.
BartlettRHRoloffDWCusterJRYoungerJGHirschlRB. Extracorporeal life support: the University of Michigan experience. JAMA. 2000;283:904-908.
16.
RobertsTE. Economic evaluation and randomised controlled trial of extracorporeal membrane oxygenation: UK collaborative trial. The Extracorporeal Membrane Oxygenation Economics Working Group. BMJ. 1998;317:911-915.
17.
GottliebJ. Update on lung transplantation. Ther Adv Respir Dis. 2008;2:237-247.
18.
ChristieJDEdwardsLBAuroraP. The Registry of the International Society for Heart and Lung Transplantation: twenty-sixth official adult lung and heart-lung transplantation report–2009. J Heart Lung Transplant. 2009;28:1031-1049.
19.
ElizurASweetSCHuddlestonCB. Pre-transplant mechanical ventilation increases short-term morbidity and mortality in pediatric patients with cystic fibrosis. J Heart Lung Transplant. 2007;26:127-131.
20.
MasonDPThuitaLNowickiERMurthySCPetterssonGBBlackstoneEH. Should lung transplantation be performed for patients on mechanical respiratory support? The US experience. J Thorac Cardiovasc Surg. 2010;139:765.e1-773.e1.
21.
HaneyaAPhilippAMuellerT. Extracorporeal circulatory systems as a bridge to lung transplantation at remote transplant centers. Ann Thorac Surg. 2011;91:250-255.
22.
de PerrotMGrantonJTMcRaeK. Impact of extracorporeal life support on outcome in patients with idiopathic pulmonary arterial hypertension awaiting lung transplantation. J Heart Lung Transplant. 2011;30:997-1002.
23.
StrueberM. Extracorporeal support as a bridge to lung transplantation. Curr Opin Crit Care. 2010;16:69-73.
24.
HämmäinenP. Re: Use of extracorporeal membrane oxygenation as a bridge to primary lung transplant: 3 consecutive, successful cases and a review of the literature. J Heart Lung Transplant. 2008;27:1186.
25.
HämmäinenPScherstenHLemströmK. Usefulness of extracorporeal membrane oxygenation as a bridge to lung transplantation: a descriptive study. J Heart Lung Transplant. 2011;30:103-107.
26.
RicciDBoffiniMDel SorboL. The use of CO2 removal devices in patients awaiting lung transplantation: an initial experience. Transplant Proc. 2010;42:1255-1258.
27.
OlssonKMSimonAStrueberM. Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation. Am J Transplant. 2010;10:2173-2178.
28.
FischerSSimonARWelteT. Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung. J Thorac Cardiovasc Surg. 2006;131:719-723.
29.
CamboniDPhilippAHirtSSchmidC. Possibilities and limitations of a miniaturized long-term extracorporeal life support system as bridge to transplantation in a case with biventricular heart failure. Interact Cardiovasc Thorac Surg. 2009;8:168-170.
30.
FuehnerTKuehnCHademJ. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med. 2012;185:763-768.
31.
DollNKiaiiBBorgerM. Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock. Ann Thorac Surg. 2004;77:151-157.
32.
SchwarzBMairPMargreiterJ. Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support. Crit Care Med. 2003;31:758-764.
33.
AsaumiYYasudaSMoriiI. Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation. Eur Heart J. 2005;26:2185-2192.
34.
ChenJSKoWJYuHY. Analysis of the outcome for patients experiencing myocardial infarction and cardiopulmonary resuscitation refractory to conventional therapies necessitating extracorporeal life support rescue. Crit Care Med. 2006;34:950-957.
35.
ChenYSLinJWYuHY. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008;372:554-561.
36.
SheuJJTsaiTHLeeFY. Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med. 2010;38:1810-1817.
37.
NicholGKarmy-JonesRSalernoCCantoreLBeckerL. Systematic review of percutaneous cardiopulmonary bypass for cardiac arrest or cardiogenic shock states. Resuscitation. 2006;70:381-394.
38.
CombesALeprincePLuytCE. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 2008;36:1404-1411.
39.
ThiagarajanRRBroganTVScheurerMALaussenPCRycusPTBrattonSL. Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in adults. Ann Thorac Surg. 2009;87:778-785.
40.
Extracorporeal Life Support Organization. Extracorporeal Life Support (ECLS) Registry report: International Summary. Ann Arbor, MI: Extracorporeal Life Support Organization; 2010.
41.
ThiagarajanRRLaussenPCRycusPTBartlettRHBrattonSL. Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation. 2007;116:1693-1700.
42.
MassettiMTasleMLe PageO. Back from irreversibility: extracorporeal life support for prolonged cardiac arrest. Ann Thorac Surg. 2005;79:178-183.
43.
SungKLeeYTParkPW. Improved survival after cardiac arrest using emergent autopriming percutaneous cardiopulmonary support. Ann Thorac Surg. 2006;82:651-656.
44.
MaggioPHemmilaMHaftJBartlettR. Extracorporeal life support for massive pulmonary embolism. J Trauma. 2007;62:570-576.
45.
RuttmannEWeissenbacherAUlmerH. Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. J Thorac Cardiovasc Surg. 2007;134:594-600.
46.
YoungerJGSchreinerRJSwanikerFHirschlRBChapmanRABartlettRH. Extracorporeal resuscitation of cardiac arrest. Acad Emerg Med. 1999;6:700-707.
47.
MégarbaneBLeprincePDeyeN. Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest. Intensive Care Med. 2007;33:758-764.
48.
ChenYSChaoAYuHY. Analysis and results of prolonged resuscitation in cardiac arrest patients rescued by extracorporeal membrane oxygenation. J Am Coll Cardiol. 2003;41:197-203.
49.
PeberdyMAKayeWOrnatoJP. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2004;58:297-308.
50.
MarascoSFPreovolosALimKSalamonsenRF. Thoracotomy in adults while on ECMO is associated with uncontrollable bleeding. Perfusion. 2007;22:23-26.
51.
OliverWC. Anticoagulation and coagulation management for ECMO. Semin Cardiothorac Vasc Anesth. 2009;13:154-175.
52.
MuehrckeDDMcCarthyPMStewartRW. Complications of extracorporeal life support systems using heparin-bound surfaces. The risk of intracardiac clot formation. J Thorac Cardiovasc Surg. 1995;110:843-851.
53.
CurtisJJWallsJTSchmaltzRADemmyTLWagner-MannCCMcKenneyCA. Use of centrifugal pumps for postcardiotomy ventricular failure: technique and anticoagulation. Ann Thorac Surg. 1996;61:296-300.
54.
HorwitzJRCoferBRWarnerBWCheuHWLallyKP. A multicenter trial of 6-aminocaproic acid (Amicar) in the prevention of bleeding in infants on ECMO. J Pediatr Surg. 1998;33:1610-1613.
55.
RastanAJLachmannNWaltherT. Autopsy findings in patients on postcardiotomy extracorporeal membrane oxygenation (ECMO). Int J Artif Organs. 2006;29:1121-1131.
56.
CoxCSJrZwischenbergerJBTraberLDTraberDLHerndonDN. Use of an intravascular oxygenator/carbon dioxide removal device in an ovine smoke inhalation injury model. ASAIO Trans. 1991;37:M411-M413.
57.
ZwischenbergerJBTaoWBidaniA. Intravascular membrane oxygenator and carbon dioxide removal devices: a review of performance and improvements. ASAIO J. 1999;45:41-46.
