Extracorporeal membrane oxygenation -- new developments.

Abstract

Extracorporeal membrane oxygenation (ECMO) has been used clinically for more than 10 years in pulmonary and cardiopulmonary failure. Intravascular devices were developed and introduced. But, due to lack of efficiency, they did not gain clinical acceptance. However, progress was made in improving the extracorporeal devices in terms of biocompatibility: less traumatizing oxygenators and pumps were developed. In addition heparin coating of the extracorporeal circuit was introduced. The cannulation technique became less invasive due to a transcutaneous approach. New treatment strategies and ventilator techniques were introduced in the last decade for respiratory insufficiency with the implication of less requirement for ECMO. However, these new treatment strategies, like nitric oxide ventilation or surfactant replacement, may be used as cotherapy with ECMO to reduce complications on ECMO or shorten the time ECMO is required. Further technical improvements are evolving like sophisticated pump control systems to reduce negative inlet pressure or pulsatile pump flow. Therefore ECMO devices have become safer and less invasive. Pharmacological cotherapy will both shift the inclusion criteria for ECMO and improve ECMO efficacy and safety.