Extracorporeal membrane oxygenation: A review

Abstract

Extracorporeal membrane oxygenation (ECMO) is used to support heart and lungs for extended periods of time till the underlying disease process is treated by use of a semi permeable membrane oxygenator .In 70s ECMO as a treatment modality in adult respiratory failure did not gain universal popularity due to no difference in outcomes when compared to conventional ventilator management. In the same period. however. neonates. especially those with persistent pulmonary hypertension of the newborn (PPHN) showed marked improvement in outcomes. Since 2009 there has been a resurgence of ECMO secondary to outbreak of H1N1 Influenza leading to severe hypoxemic respiratory failure .Currently ECMO is considered as a valid alternative if there is a failure of conventional therapies.This article reviews the use of ECMO with specific indications and management strategies with respect to Pediatric ECMO mainly.Actual equipment of ECMO has also evolved over time to be smaller and with better precision. Development of biocompatible oxygenators and coated circuits to reduce the complications of consumptive coagulopathy and thrombocytopenia. The shift from roller pump ECMO machines, which are mainly gravity dependent for achieving flow to magnetically driven centrifugal ECMO pumps, has made noticeable change to the practice.In the last part of review Indian scenario and setting up of an ECMO program is also discussed briefly.

Keywords

• ecmo
• extracorporeal membrane oxygenation
• venovenous ecmo
• respiratory ecmo
• venoarterial ecmo
• cardiac ecmo