Outline the role of ECMO (Extracorporeal membrane oxygenation) as a supportive strategy in the critically ill.
Answer and interpretation
ECMO is indicated as a supportive strategy for patients (adults, children and neonates) with potentially reversible acute severe heart or lung failure with a high mortality risk despite conventional therapy.
- Veno-venous or veno-arterial
Evidence for use of ECMO
- ECMO has proven benefit as a supportive strategy in neonates with cardiorespiratory failure. The International Registry reports 75% survival to discharge for neonates on ECMO.
- Recent studies have shown a benefit for the use of ECMO in adult respiratory failure but the evidence for its use in cardiac failure is still poor. CESAR Trial from the UK compared ECMO and conventional ventilation for severe acute respiratory failure in 160 patients with improved 6 month survival in the ECMO group (63% versus 47%). The Australasian experience of the 2009 influenza A (HINI) pandemic (ANZ ECMO Influenza Investigators) reported 68 patients who received ECMO with 21% mortality. All these patients met inclusion criteria for the CESAR trial.
- ECMO also used as a rescue strategy for cardiac arrest (ECPR).
- Several centres world-wide have experience in retrieval and transport of patients with ECMO.
- Circuit related
- ECMO remains a specialised strategy requiring appropriate resources and personnel.
- However its use should be limited to centres with appropriate expertise, resources and experience and facilities for transport and retrieval should be supported.