[Extracorporeal membrane oxygenation (ECMO) in adults]

Area of Science:

• Critical care medicine
• Respiratory medicine
• Cardiopulmonary support

Context:

• Extracorporeal membrane oxygenation (ECMO) is a vital treatment for acute lung injury and ARDS.
• Despite widespread institutional experience, randomized controlled trials have not demonstrated reduced mortality compared to conventional treatment.
• The incidence of ECMO use in adults has decreased in recent years due to various factors.

Purpose:

• To review the current status of ECMO in adult ARDS treatment.
• To outline the evolving inclusion and exclusion criteria for ECMO therapy.
• To emphasize the importance of specialized reference centers for optimal ECMO outcomes.

Summary:

• ECMO, while an important option for acute lung injury and ARDS, has not shown reduced mortality in RCTs, leading to recommendations against its use in ARDS.
• Inclusion criteria involve severe gas exchange disorders and lung injury scores, while contraindications include poor prognosis conditions and organ failure.
• Experience suggests early referral to ECMO reference centers improves patient outcomes.

Impact:

• Highlights the need for careful patient selection and management in ECMO therapy.
• Suggests a shift towards centralized care models for complex extracorporeal treatments.
• Informs clinical decision-making regarding the application of ECMO in severe respiratory failure.