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.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.