Extracorporeal membrane oxygenation and mechanical support for the circulation

Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonary bypass which can be used to support neonates, paediatric and adult patients with severe cardiac and or respiratory failure for days, weeks and in some cases months. One of the key principles for a successful outcome from ECMO is careful patient selection. Candidates for ECMO must have a potentially reversible pathology and have no absolute contraindication to ECMO such as a severe brain haemorrhage, lethal chromosomal anomaly or an end-stage chronic condition. ECMO carries a high risk of complications both in the patient (e.g. cerebral thrombosis and infection) and with the extracorporeal circuit (air embolus, thrombus, circuit component problems such as an oxygenator failure). Given the risks of ECMO, it is vital that the ECMO patient (and circuit) is managed 24/7 by a fully trained specialist ECMO team. The outcome of ECMO depends largely on the indication for ECMO. Usually, ECMO is only considered for the most severely ill patients already on maximum conventional therapy who without ECMO, have a very high risk of mortality.