Extracorporeal Membrane Oxygenation (ECMO)

Extra Corporeal Membrane Oxygenation (ECMO) has made much progress over recent years. It has become an invaluable tool in the care of patients with severe cardiac and pulmonary failure refractory to conventional medical management. ECMO treatment has become more reliable with advanced equipment and technology, better patient monitoring and improved experience and understanding, which is reflected in improved results. Moreover, ECMO indications are extended to prolonged use in intensive care unit, such as bridge to transplant, for both cardiac and lung transplant and support for lung resections in unstable patients. According to the Extracorporeal Life Support Organization (ESLO) registry, ECMO was used in less than 5,000 cases prior to 2010 compared to 18,000 cases in 2021. In 1990, ECMO was initially started in 83 centers; those numbers increased to 492 centers by 2020. The immense increase of patients treated with ECMO and the vast expansion to its indications raises opportunity to expand the training and services to incorporate more ECMO centers especially within the country.

An ECMO machine consists of a pump with an oxygenator that replaces similar functions of the heart and lung, respectively. Therefore, the primary purpose of ECMO is to give these organs time to rest and recover. Veno-venous ECMO (VV ECMO) provides respiratory support, whereas veno-arterial ECMO (VA ECMO) provides cardio-respiratory support.

ECMO should only by performed by clinicians with training and experience in its initiation, maintenance, and discontinuation. ECMO is a supportive therapy rather than a disease modifying treatment in itself. However, the determining factor of ECMO treatment success lies fundamentally in the right patient selection. The indications and patient selection, technical aspects including types and configuration of the ECMO circuit, complications and impact of ECMO on clinical outcomes will be discussed in the session. Additionally, few areas of importance that gives rise to better clinical outcomes will also be highlighted and discussed.