State of the Art Review: Extracorporeal Membrane Oxygenation (ECMO): A Life-Saving Therapy And Its Challenges of Implementation In Emerging Healthcare Systems
Vedat Eljezi, MD, PhD
Department of Anesthesia, Critical Care and Perioperative Medicine
CHU Clermont-Ferrand, 58 rue Montalembert, 63001 Clermont-Ferrand Cedex 1, France
Email: [email protected]
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Abstract:
Extracorporeal membrane oxygenation (ECMO) is an advanced life support technology for critically ill patients experiencing severe cardiac and respiratory failure unresponsive to conventional treatment. By facilitating extracorporeal gas exchange and circulatory support, ECMO allows recovery from injury and acts as a bridge to transplantation or long-term support. Since its inception in the 1970s, ECMO’s applications have expanded from a last-resort intervention to an integral part of advanced critical care, particularly in cases of acute respiratory distress syndrome (ARDS), cardiogenic shock, and refractory cardiac arrest. Key studies, including the CESAR and EOLIA trials, underline ECMO’s role in improving survival rates in severe ARDS when applied in specialized centers. Despite its effectiveness, ECMO poses significant technical challenges, resource demands, and complications such as bleeding and infection. Moreover, the COVID-19 pandemic underscored the need for ECMO in critical care but also highlighted the difficulties of implementation in resource-limited settings. The technical functioning of ECMO involves veno-venous (VV-ECMO) solely for respiratory support and veno-arterial (VA-ECMO) catering to both cardiac and respiratory needs. Contemporary systems utilize advanced materials and monitoring for improved patient outcomes. Addressing the logistical and financial barriers to ECMO integration into healthcare systems is crucial for its sustainable and safe application globally.
Keywords: ECMO; extracorporeal membrane oxygenation; respiratory failure; cardiac support; ARDS; complications; critical care; healthcare challenges.