[Extracorporeal heart and lung replacement procedures]

Area of Science:

• Cardiopulmonary support technologies
• Critical care medicine
• Respiratory and cardiac failure management

Context:

• Extracorporeal support systems are established treatments for cardiac and pulmonary failure.
• Evidence for extracorporeal membrane oxygenation (ECMO) in severe respiratory failure is growing.
• Extracorporeal life support (ECLS) is increasingly used for cardiogenic shock and as a bridge to transplantation.

Purpose:

• To review the established and emerging applications of extracorporeal support systems.
• To highlight the technical distinctions between pump-driven and pumpless systems.
• To emphasize the critical need for specialized centers due to the invasive nature and potential complications.

Summary:

• Veno-venous ECMO is a life-saving procedure for severe respiratory failure, supported by trials like CESAR.
• Veno-arterial ECLS is utilized for cardiogenic shock, post-transplantation, and advanced resuscitation.
• Pumpless extracorporeal lung assist (pECLA) aids in hypercapnic respiratory failure by facilitating lung-protective ventilation.

Impact:

• Technical advancements in extracorporeal devices are significant.
• These invasive procedures are associated with major complications.
• Widespread use is not recommended; restrict to expert centers.