Extracorporeal life support: moving at the speed of light

Extracorporeal life support (ECLS), or extracorporeal membrane oxygenation (ECMO) as it is also known, has been used to support over 45,000 patients to date. Overall survival is 62%. After many years of no change in equipment and technology, there has been a recent flurry of new pumps, cannulas, and oxygenators available for ECLS use. While the impact of this new technology is not yet completely defined, initial results have found that these systems provide safe support with lower priming volumes and less bleeding complications. New cannulas are also available, some making it easier for venovenous support in patients, from infants through adults. The reported success of ECLS in patients with H1N1 during the 2009-2010 epidemic and the improved survival of patients randomized to the ECMO arm of a recently completed adult study of respiratory failure have also brought ECLS into the spotlight much more than other years. Whether these developments will usher in a new era of ECLS expansion to a wider range of patients will require close consideration and observation. Other areas that need to be further refined include anticoagulation management, treatment of bleeding complications, learning to "nurse" patients in an awake state, such as is done in some European (and a few United States) centers, and neurodevelopmental outcome on a long-term basis.