ECMO for adult respiratory failure: current use and evolving applications

Area of Science:

• Cardiopulmonary support
• Respiratory medicine
• Critical care

Background:

• Extracorporeal membrane oxygenation (ECMO) use is rising for severe adult respiratory failure.
• Technological advancements and accumulating evidence drive this growth.
• ECMO applications are expanding beyond acute respiratory distress syndrome (ARDS).

Purpose of the Study:

• To review the expanding applications of ECMO in adult respiratory failure.
• To discuss the evolving role of extracorporeal carbon dioxide removal (ECCO2R).
• To explore the potential of ECMO in managing chronic respiratory conditions and facilitating patient recovery.

Main Methods:

• Literature review of current ECMO applications and evidence.
• Analysis of ECMO's role in various hypoxemic and hypercapnic respiratory failures.
• Discussion of emerging uses, including extracorporeal carbon dioxide removal (ECCO2R).

Main Results:

• ECMO is used for ARDS, hypoxemic/hypercapnic failure, lung transplant bridging, and pulmonary hypertensive crises.
• ECCO2R is an evolving application for less severe ARDS and hypercapnic failure.
• ECMO may allow liberation from mechanical ventilation and enable physical therapy.

Conclusions:

• ECMO is a versatile tool for severe respiratory failure with expanding indications.
• Emerging research suggests ECMO could lead to an artificial lung, transforming chronic respiratory failure treatment.
• Further research is needed to solidify evidence and optimize ECMO strategies.