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Education in Heart
Acute cardiovascular care
Extracorporeal membrane oxygenation: indications, technique and contemporary outcomes
  1. Jason Ali1,
  2. Alain Vuylsteke2
  1. 1 Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
  2. 2 Intensive Care, Papworth Hospital, Cambridge, UK
  1. Correspondence to Jason Ali, Cardiothoracic Surgery, Papworth Hospital, Cambridge CB23 3RE, UK; ja297{at}cam.ac.uk

https://doi.org/10.1136/heartjnl-2017-311928

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    Learning objectives

    • Develop an understanding of extracorporeal membrane oxygenation (ECMO) and the differences between veno-venous and veno-arterial ECMO.

    • Develop an understanding of the range of conditions that can be managed with ECMO and the contraindications.

    • Develop an appreciation of the common complications that patients suffer when supported with ECMO.

    Introduction

    Extracorporeal membrane oxygenation (ECMO) is an advanced form of temporary life support, to aid respiratory and/or cardiac function. It has been used since the early 1970s and is based on cardiopulmonary bypass technology and diverts venous blood through an extracorporeal circuit and returns it to the body after gas exchange through a semi-permeable membrane. ECMO can be used for oxygenation, carbon dioxide removal and haemodynamic support. Additional components allow thermoregulation and haemofiltration. The two most common forms of ECMO are veno-venous (VV) and veno-arterial (VA). In VV-ECMO, used to support gas exchange, oxygenated blood is returned to a central vein. In VA-ECMO, used in cases of cardiac or cardiorespiratory failure, oxygenated blood is returned to the systemic arterial circulation, bypassing both the heart and lungs.

    History

    The first adult survivor of ECMO was reported in 1972 in a patient who developed respiratory failure following a trauma.1 This was followed in 1976 with report of successful outcomes in moribund infants.2 The first randomised controlled trial (RCT) of VV-ECMO was performed in 1979 in 90 adult patients with respiratory failure and reported a high mortality rate and ECMO-associated complications.3 Today, this outcome is attributed to the old ECMO technology used and poor ventilatory management of patients. This trial diminished significantly the initial enthusiasm for ECMO in adult patients even if good outcomes continued to be observed when ECMO was used in young patients.4 In 1989, a group of enthusiast clinicians formed the Extracorporeal Life Support Organization (ELSO) and established a voluntary registry to …

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    Footnotes

    • Contributors The manuscript was written by JA and AV. Both authors reviewed and prepared the final manuscript for submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Patient consent for publication Not required.