Extracorporeal life support: experience with 2,000 patients.

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.