Extracorporeal Membrane Oxygenation: How Do We Do It?
ECMO support should be considered whenever a critically ill patient has severe respiratory or cardiorespiratory failure and conventional circulatory or respiratory therapy has failed or is anticipated to be inadequate to support vital organ function. Intuitively, like most acute life-supportive interventions, the earlier ECMO support is initiated when required, the more likely a desired clinical outcome can be achieved. Patients considered appropriate for ECMO support should have reversible clinical conditions that are expected to have realistic chances of recovery or have available options for more durable, long-term support when the primary indication is for circulatory failure. The variety of different clinical scenarios in which ECMO support has been utilized has markedly expanded over the last two decades, particularly as management of critically ill patients has improved and ECMO technology continues to evolve and is applied by a wider clinical audience. It is now important for all intensivists to have a basic understanding of ECMO principles and practices and particularly the indications for referral for consideration of ECMO.