Adult Extracorporeal Membrane Oxygenation: An Update for Intensivists

Abstract

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 Venous blood is continuously withdrawn from a patient and passed across a membrane that can support both oxygenation and removal of carbon dioxide; blood is then reinfused back into the patient via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...