Extracorporeal life support
| Extracorporeal membrane oxygenation | |
|---|---|
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| ICD-10-PCS | 5A15223 |
| ICD-9-CM | 39.65 |
| MeSH | 29295 |
| MedlinePlus | 007234 |
Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support.
This intervention has mostly been used on children, but it is seeing more use in adults with cardiac and respiratory failure. ECMO works by removing blood from the person's body and artificially removing the carbon dioxide and oxygenating red blood cells. Generally it is used either post-cardiopulmonary bypass or in late stage treatment of a person with profound heart and/or lung failure.
Guidelines that describe the indications and practice of ECMO are published by the Extracorporeal Life Support Organization (ELSO). Criteria for the initiation of ECMO vary by institution, but generally include acute severe cardiac or pulmonary failure that is potentially reversible and unresponsive to conventional management. Examples of clinical situations that may prompt the initiation of ECMO include the following:
In those with cardiac arrest or cardiogenic shock it appears to improve survival and good outcomes.
A registry of patients that have received ECMO is maintained by the Extracorporeal Life Support Organization (ELSO). The last publication of ELSO registry data reported outcomes on nearly 51,000 patients with 75% survival for neonatal respiratory failure, 56% survival for pediatric respiratory failure, and 55% survival for adult respiratory failure. With acute respiratory failure use of ECMO has been shown to improve survival rates. Survival rates from 50 to 70 percent have been reported in observational and uncontrolled clinical trials. The survival rates reported are better than historical survival rates. In the United Kingdom, respiratory (VV) ECMO is concentrated in designated ECMO centres to ensure top-quality care.
Most contraindications are relative, balancing the risks of the procedure (including the risk of using valuable resources that could be used for others) versus the potential benefits. The relative contraindications are:
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