Extracorporeal life support: updates and controversies

Area of Science:

• Cardiology
• Critical Care Medicine
• Pediatric Critical Care

Background:

• Extracorporporeal Life Support (ECLS) utilization has significantly increased globally.
• Over 4000 patients annually receive ECLS across more than 200 centers.
• Advances in ECLS technology and patient management strategies are crucial.

Purpose of the Study:

• To review recent advancements in ECLS technology, including novel pumps and oxygenators.
• To discuss current controversies and best practices in ECLS management.
• To explore emerging models for ECLS delivery and regionalization.

Main Methods:

• Literature review focusing on recent publications and guidelines.
• Analysis of technological innovations in ECLS devices.
• Discussion of clinical management challenges and proposed solutions.

Main Results:

• Introduction of magnetically levitated centrifugal pumps and hollow-fiber gas-exchange devices.
• Exploration of debates on ECLS indications, cannulation, anticoagulation, and weaning.
• Presentation of shifts towards single-provider models and regionalized ECLS care.

Conclusions:

• ECLS technology continues to evolve, offering improved efficiency and safety.
• Addressing management controversies is essential for optimizing patient care.
• System-level changes in ECLS delivery are reshaping patient access and outcomes.