Assistance cardiorespiratoire par extracorporeal membrane oxygenation (ECMO)

Critical care physicians should recognize early in the course of the disease severe cardiogenic shock complicating acute myocarditis, intoxication with cardiotoxic drugs, myocardial infarction and peripartum cardiomyopathy. In such situations, extracorporeal membrane oxygenation (ECMO) is emerging as the technique of choice and patients rapidly progressing to refractory cardiac failure should be immediately transferred to a referral medical-surgical center experienced in mechanical circulatory support. For highly unstable patients, a Mobile Cardiac Assistance Unit, which may rapidly travel to other hospitals with a portable ECMO system and install the device before refractory multiorgan failure takes hold, may be created. Such a strategy of emergency ECMO support can rescue up to 40% of otherwise fatal cardiogenic shock patients. ECMO may also significantly improve the outcomes of the most severe forms of the Acute Respiratory Distress Syndrome. However, more data from carefully designed randomized trials are awaited, before ECMO can be widely adopted in this indication.