[Extracorporeal membrane oxygenation : System selection, (contra)indications, and management]

Area of Science:

• Critical Care Medicine
• Cardiopulmonary Support
• Respiratory Therapy

Background:

• Extracorporeal membrane oxygenation (ECMO) encompasses diverse systems and configurations.
• Tailoring ECMO therapy necessitates thorough planning based on individual patient needs.
• Current trends suggest a lower threshold for initiating respiratory ECMO.

Purpose of the Study:

• To outline the considerations for utilizing ECMO in severe acute respiratory distress syndrome (ARDS).
• To discuss the relative nature of contraindications and the importance of risk-benefit assessment in ECMO therapy.
• To address the challenges in determining ECMO futility and the need for evidence-based cessation criteria.

Main Methods:

• Review of current ECMO systems and configurations.
• Analysis of patient-specific factors influencing ECMO indication and management.
• Evaluation of decision-making processes for ECMO initiation and termination.

Main Results:

• ECMO patient management requires individualized therapeutic planning.
• Severe ARDS patients unresponsive to conventional treatments may be candidates for ECMO.
• Contraindications are relative, demanding careful risk-benefit evaluation for both initiation and cessation.

Conclusions:

• Personalized planning is crucial for effective ECMO implementation.
• ECMO is a potential therapy for refractory severe ARDS.
• Evidence-based guidelines for ECMO futility and cessation are lacking, necessitating individualized clinical judgment.