An overview of extracorporeal membrane oxygenation (ECMO)

Extracorporeal membrane oxygenation is used for unresponsive cardiorespiratory failure in neonates, children and adults. There is good evidence of its efficacy in neonates and adults and as such it is reasonable that children are referred for ECMO when faced with severe cardiorespiratory failure.Whilst the average length of stay for survivors on ECMO is about one week patients who are in single organ failure i.e. respiratory failure have been looked after for many weeks on ECMO with successful outcomes. Patient selection is crucial to the success of any ECMO programme and the underlying functionality of the patient as well as the potential reversibility of the disease are good selection criteria for putting patients on ECMO.Overall ECMO results are very encouraging across the age groups with survival rates of over 70% in most populations. The key to successful patient outcomes and a successful programme is a highly trained experienced and multidisciplinary team who are able to cannulate patients in emergency situations, troubleshoot problems with the ECMO circuit whilst providing state of the art intensive care to patients.Relatively new modalities of ECMO such as ECPR and Mobile ECMO throw up very significant ethical challenges for ECMO services in terms of patient selection and outcomes associated with rescue therapy for highly moribund patients.