Extracorporeal Membrane Oxygenation for Adults and Children With Severe Respiratory Failure

ABSTRACT

Extracorporeal membrane oxygenation, or ECMO, is a form of life support technology used in situations of critical, life-threatening illness. By circulating the patients' blood through an artificial "lung” or membrane, it delivers oxygen and removes carbon dioxide to meet the patient's metabolic needs. There are 2 primary types of ECMO delivery based on clinical needs. Veno-arterial ECMO (VA ECMO) is primarily for those patients with cardiac or cardiopulmonary failure or in need of cardiac or cardiopulmonary support. Veno-venous ECMO (VV ECMO) is administered to those patients with respiratory failure or in need or respiratory support. Typically, ECMO is used to provide time for the patient to recover, as a bridge to organ transplant, or to enable other surgeries or therapies. ECMO is resource-intensive procedure that requires large, multidisciplinary teams and constant one-on-one nursing care, typically offered in intensive care units (ICUs) in urban settings. Patients are often referred to ECMO following a rapid and critical decline in their condition, and clinicians have to assess the patient and decide on a course of treatment under pressure. Patients are often critically ill and sedated;therefore, family members are often involved in treatment decision-making. Once on ECMO, multiple complications can arise, including bleeding at the site of the cannula(s), cerebral hemorrhage or stroke, organ failure, lung injury or failure of lung recovery, and infection. Because the treatment requires being stationary in an ICU, further complications include skin or pressure ulcers, infection, pain, and, if not sedated, delirium and fear. Long-term consequences of ECMO include muscle loss, pain at the site of the cannula, and psychological consequences such as anxiety and depression. There is growing interest in ECMO nationally and internationally. The Extracorporeal Life Support Organization, an international voluntary registry, reports a growing number of adults worldwide who underwent ECMO over the past decade. Recently, ECMO has been used to treat COVID-19 patients with severe respiratory failure during the pandemic. This has led to additional pressures on ECMO centres and highlighted the potential role of ECMO in the treatment of COVID-19., The purpose of this report is to provide insights from the qualitative literature on the perspectives of those engaging with ECMO, including patients, their family, and their caregivers to support decision-making around the provision and delivery of ECMO for respiratory failure.