Extracorporeal Membrane Oxygenation in Critical Care: Past, Present, and Future

Abstract

AbstractExtracorporeal membrane oxygenation (ECMO) provides support for cardiac and pulmonary failure, and it was introduced into clinical practice over 40 years ago. The translation of surgical extracorporeal circulation into long-term support was enabled by the development of efficient, biocompatible artificial lungs and blood pumps. Early clinical trials in adult patients did not support clinical benefit in acute respiratory failure, but they were plagued by lack of center experience, older approaches to management, and lack of understanding of ventilator-induced lung injury. Recent clinical trials and retrospective studies, however, suggest a benefit in selected patients. Three neonatal trials for respiratory failure led to ECMO as a standard of care in this population, as well as in the pediatric population despite lack of controlled trials. Cardiac support with ECMO took a foothold in the management of pediatric congenital heart disease in the perioperative period, and subsequently expanded to adult cardiac failure for both perioperative and nonsurgical indications. Presently, ECMO is used to support a variety of etiologies of cardiac and pulmonary failure in all age groups. Expanding indications include support of septic shock, cardiopulmonary arrest, and donation after cardiac death, as well as bridging patients with chronic disease to transplant or long-term support devices. The future is focused on developing integrated support systems, overcoming the requirement for anticoagulation, and perfecting long-term implantable or paracorporeal pulmonary support systems.