Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions

Abstract

Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the existing literature on the potential use of ECMO in critically ill patients within the emergency department.

Comparison of extracorporeal and conventional cardiopulmonary resuscitation: A meta-analysis of 2 260 patients with cardiac arrest

“…IHCA treated with CCPR typically has a survival rate of 15%-17% and OHCA survival is even lower than 8%-10%. [15] The worst outcomes are in patients with prolonged time to ROSC. Several factors are related to the outcomes, including immediate recognition of CA, early CPR, rapid defibrillation, initial rhythm, underlying cause of CA, duration of CPR and initial resuscitation effort as well as integrated post-CA care.…”

“…IHCA patients are much more likely to have witnessed CA with a shorter duration to achieve advanced cardiac life support, and with a shorter time until start of ECPR and that comorbidities are known to the treating physician implicating a bias in decision for ECMO implantation. [15] Several observational studies have found variable improvements in mortality with the use of ECPR. Haneya et al [21] compared ECPR initiated in the ED for OHCA with ECPR initiated for IHCA, and found a survival rate of 42% for IHCA patients versus only 15% for OHCA patients.…”

“…While an optimistic estimate of survival from OHCA with the use of ECPR may be in the 15%-20% range, the critical factor that determines success appears to be the duration from the onset of arrest to achieving ECMO flow. [15] This may be why IHCA studies have generally reported better outcomes. [22] When ECPR can be initiated rapidly, the outcomes for OHCA may be similar to those seen with IHCA patients.…”

Terapia de reemplazo renal continua en el paciente con oxigenación por membrana extracorpórea: consideraciones para la combinación de ambas terapias

“…El ECMO es un sistema de apoyo temporal que reemplaza la función de pulmones y corazón para devolver la homeostasis a los otros órganos, mientras se administra la terapia modificadora de la enfermedad o se espera la resolución del compromiso cardiorrespiratorio 1 . Estos pacientes, por lo general, tienen compromiso multisistémico, siendo frecuente la afectación cardiaca, pulmonar y renal concomitante.…”

“…, sin embargo, después de 2009, con la publicación del estudio CESAR, ha habido una expansión significativa del uso de ECMO 1 . Esta investigación evidenció la mejoría en la supervivencia en pacientes con síndrome de distrés respiratorio agudo (SDRA) tratados con ECMO durante la pandemia de gripe H1N1.…”