Extracorporeal Membrane Oxygenation: Past, Present and Future / 대한내과학회지

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) was originated from heart-lung machine for cardiac surgery. This technique that receive the blood from venous system, oxygenate it and support to selected patients with severe respiratory or cardiac failure as flow and oxygen. ECMO can provide partial or total support, is temporary, and requires systemic anticoagulation. ECMO controls gas exchange and perfusion, stabilizes the patient physiologically, decreases the risk of ongoing iatrogenic injury, and allows enough time for decision, diagnosis, treatment, and recovery from the primary injury or disease. The two major ECMO modalities are venoarterial and venovenous. Until 1980s, ECMO usually used to pediatric respiratory failure. However after H1N1 influenza epidemic in the world, venovenous ECMO support for adult has been increased rapidly. Venoarterial ECMO support for cardiac failure and resuscitation also abruptly has been increased. As a support modality, cannula position and possibility of complication is different. Survival rate of ECMO has a range from 30% in extracorporeal cardiopulmonary resuscitation to 70% for acute myocarditis and acute respiratory distress syndrome in adult, and better in neonate and pediatrics. Advancing ECMO technology and increasing experience with ECMO techniques have improved patient outcomes, reduced complications and expanded the potential applications of ECMO. Awareness of the indications and implications of ECMO among physicians managing patients with severe but potentially reversible respiratory or cardiac failure may help facilitate better communication between health care teams and improve patient recovery.