Extracorporeal Membrane Oxygenation: Indications and Use

Extracorporeal membrane oxygenation (ECMO) is a temporary form of mechanical cardiopulmonary support developed for use outside of the operating room. Although initially conceived as an extension of cardiopulmonary bypass, the indications for and utilization of ECMO have grown substantially in the last 20 years. Although there are a variety of configuration strategies, ECMO support generally consists of veno-venous (VV) and veno-arterial (VA) ECMO and, also, extracorporeal cardiopulmonary resuscitation (ECPR), which is a form of VA-ECMO used as support or rescue during cardiac arrest. Growth in ECMO has been supported by improvements in ECMO cannula and circuit technology. In addition, ECMO utilization has largely expanded driven by patient need. The high incidence of advanced cardiac and lung disease, recent respiratory viral pandemics, relative stagnation in outcomes in critically ill patients with cardiac or respiratory failure, and growth of mechanical circulatory support and heart and lung transplant programs have all been factors in bringing ECMO to the forefront of modern critical care. However, the risks of ECMO and resources required to implement a program are substantial, and a nuanced understanding of the potential benefits, indications, and contraindications is necessary for optimal utilization and minimization of harm and cost. With this in mind, ECMO is likely to be a beneficial and life-saving therapy for appropriately selected patients with critical illness due to advanced cardiac or pulmonary disease.