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Extracorporeal life support: experience with 2,000 patients.

Brian W Gray1, Jonathan W Haft, Jennifer C Hirsch

  • 1From the *Departments of Surgery, †Cardiac Surgery, and ‡Pediatrics, University of Michigan, Ann Arbor, Michigan.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
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Extracorporeal life support (ECLS), or ECMO, successfully treated 2,000 patients with acute heart or lung failure. This review highlights ECLS

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Area of Science:

  • Cardiology
  • Pulmonology
  • Critical Care Medicine

Background:

  • Extracorporeal life support (ECLS), also known as extracorporeal membrane oxygenation (ECMO), is a vital technology for managing patients with severe cardiopulmonary failure.
  • The University of Michigan has a long-standing experience in managing patients with ECLS, dating back to 1973.

Purpose of the Study:

  • To review the University of Michigan's extensive experience with ECLS over a 37-year period (1973-2010).
  • To analyze survival rates and complications in a large cohort of patients treated with ECLS across different age groups and conditions.

Main Methods:

  • A retrospective review of 2,000 patients managed with ECLS between 1973 and 2010.
  • Analysis of patient demographics, indications for ECLS, survival to discharge, and complication rates.

Main Results:

  • Overall, 74% of patients were weaned from ECLS, with 64% surviving to hospital discharge.
  • Survival rates varied by condition and age: 84% for neonates with respiratory failure, 50% for adults with respiratory failure, and 38% for adults with cardiac failure.
  • Survival decreased from 74% to 55% between the first and second 1,000 patients treated.
  • The most common complication was bleeding (39%), while pump malfunction was rare (2%). Intracranial bleeding or infarction occurred in 8% of patients.

Conclusions:

  • ECLS is a life-saving therapy for critically ill patients with acute pulmonary and cardiac failure across all age groups.
  • Continuous evaluation and improvement in ECLS management are essential, as evidenced by the observed decrease in survival between patient cohorts.
  • Despite complications like bleeding, ECLS remains a critical intervention for moribund patients when other therapies fail.