Extra-Corporeal Membrane Oxygenation (ECMO), or Extra-Corporeal Life Support (ECLS) is a means of providing respiratory and/or cardiac support to patients in the setting of reversible cardiac or respiratory failure that is refractory to conventional management.
The two main forms of ECMO are veno-venous and veno-arterial (EdECMO).
Veno-venous ECMO is indicated in acute respiratory failure, where cardiac function is normal. Some indications include pneumonia, ARDS, aspiration and status asthmaticus. It involves removing blood from the venous circulation, oxygenating it via the extracorporeal membrane and then returning blood to the venous circuit close to the right atrium. This allows oxygenated blood to flow through the pulmonary circulation and then to the rest of the body.
Veno-arterial ECMO is indicated when complete or partial cardiac support is required in addition to extracorporal gas exchange. Indications include failure to wean post cardiopulmonary bypass, non-ischaemic cardiogenic shock and in bridging to LVAD. It involves removing blood from the venous circulation, facilitating extracorporeal gas exchange and then returning oxygenated blood to the aorta.
According to the Cochrane Review of ECMO, published in January 2015, overall benefits of ECMO are yet to be fully elicited, however there have been some promising results in various trials, such as the CESAR trial of VV ECMO.
There are however a number of significant risks associated with using extracorporeal oxygenation including haemorrhage, thrombosis, pump failure and cardiac arrest and as such should only be used in appropriate centers, in appropriate patients, with appropriately trained operators.
The Cardiohelp System is a portable ECMO device that enables patient transport without compromising the ECMO circuit. In this video, Dr Paul Forrest demonstrates the use of the Cardiohelp System including how to manually operate the pump, the different monitoring features and much more!