Experimental and Clinical Experiences with Prolonged Oxygenation and Assisted Circulation

The Early History of Extracorporeal Membrane Oxygenation

“…Concomitantly, doctors at the Pacific Medical Center, San Francisco, began using a Bramson membrane 14 heart-lung machine to provide partial VA and VV ECMO to adults with cardiogenic shock 19 , or hypoxic respiratory failure refractory to mechanical ventilation with 100% oxygen 19,20 . The individuals treated were universally moribund at the initiation of extracorporeal therapy, and between 1966 and 1970, there were no long-term survivors.…”

Principles of venovenous extracorporeal membrane oxygenation

“…These pioneers used partial venoarterial (VA) ECMO to support this patient, although they had also described the preclinical and clinical use of venovenous (VV) ECMO in earlier reports. 2,3 The contemporary experience with both VV and VA ECMO was recently reviewed by Squiers and colleagues 4 in this Journal. VV ECMO has become an important therapy for severe respiratory failure in adults.…”

“…8 In addition, the described patient 5 had high cardiac output develop, and thus the amount of undrained IVC flow likely surpassed the drainage capacity of the cannula or may have surpassed drainage capacity because ECMO pump flows were set at lower values than the intrinsic cardiac output. Increasing VV ECMO pump flows thus may decrease the total undrained systemic venous flow [2] while increasing the net VV ECMO output flow [1]. Finally, cardiac venous flow [3] is generally considered to comprise a negligible portion of cardiac output (3%).…”

“…In essence, hypoxemia in the patient supported by VV ECMO can be avoided by maximizing net VV ECMO output flow [1] and minimizing total undrained systemic venous return [2]. Sometimes it is not possible to capture all sources of systemic venous return because of difficult vascular access and anatomy, or the addition of an addi-tional cannula is felt to be prohibitively risky.…”

Weaning-Related Shock in Patients With ECMO: Incidence, Mortality, and Predisposing Factors

“…EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) was first used nearly 50 years ago. 1,2 It has been implemented as a treatment for pulmonary and cardiac failure 3 and is particularly used in patients with cardiogenic shock after cardiotomy, a condition that can be fatal without mechanical circulatory support. [4][5][6][7] The Extracorporeal Life Support Organization (ELSO) database shows the exponential increase in the use of venoarterial (VA)-ECMO in these cases.…”