Extracorporeal Life Support: Moving at the Speed of Light

Abstract

Extracorporeal life support (ECLS), or extracorporeal membrane oxygenation (ECMO) as it is alsoknown, has been used to support over 45,000 patients to date. Overall survival is 62%. After many years of no change in equipment and technology, there has been a recent flurry of new pumps, cannulas, and oxygenators available for ECLS use. While the impact of this new technology is not yet completely defined, initial results have found that these systems provide safe support with lower priming volumes and less bleeding complications. New cannulas are also available, some making it easier for venovenous support in patients, from infants through adults. The reported success of ECLS in patients with H1N1 during the 2009 -2010 epidemic and the improved survival of patients randomized to the ECMO arm of a recently completed adult study of respiratory failure have also brought ECLS into the spotlight much more than other years. Whether these developments will usher in a new era of ECLS expansion to a wider range of patients will require close consideration and observation. Other areas that need to be further refined include anticoagulation management, treatment of bleeding complications, learning to "nurse" patients in an awake state, such as is done in some European (and a few United States) centers, and neurodevelopmental outcome on a longterm basis.

Arteriovenous extracorporeal membrane oxygenation for cardiac arrest/cardiogenic shock

“…Published case series suggest that time to commencing VA-ECMO is critical to its success and should be limited to 30-60 min after cardiac arrest [7,8] whereas age, an independent predictor of in-hospital mortality, is arbitrarily defined [9]. Furthermore, while ECMO pump devices, tubing and cannulation procedures are becoming increasingly sophisticated and more compact mobile systems are available [10], the use of VA-ECMO is still associated with significant morbidity [11].…”

Use of a Daily Lung Compliance Evaluation to Track Progress on ECMO: Successful Use in a Patient With Cystic Fibrosis

“…With improved technology, experience and success, ECMO is increasingly offered to patients with significant comorbidities, some of which might have been considered contraindications in the past [4,5]. For cystic fibrosis, ECMO has been successfully used as a bridge for lung transplantation in end stage lung disease [8,14].…”

“…ECMO is a rescue therapy for select patients with severe respiratory failure [1][2][3][4][5] that facilitates rest for the lungs and recovery by using non-toxic ventilatory settings while providing adequate gas exchange [7]. With improved technology, experience and success, ECMO is increasingly offered to patients with significant comorbidities, some of which might have been considered contraindications in the past [4,5].…”

“…Such advances include improvements in cannulation techniques, pumps and oxygenator technology, and anticoagulation management. Given these technical advances, the success of ECMO has improved substantially, increasing the survival of pediatric respiratory ECMO from 57% to 72% over the past two decades [4,5]. The traditional absolute or relative contraindications for ECMO (including congenital or acquired immune deficiencies and underlying respiratory disease) are now challenged.…”

Neonatal and Pediatric Respiratory Care: What Does the Future Hold?

“…69 Much has been learned from the ECMO experience of the over 45,000 patients in the Extracorporeal Life Support Organization registry (http:// www.elso.med.umich.edu).…”