Extracorporeal Life Support: Four Decades and Counting

Area of Science:

• Cardiology
• Pulmonology
• Critical Care Medicine
• Biomedical Engineering

Background:

• Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is a vital technique for patients with cardiorespiratory failure.
• It functions as a heart-lung bypass, supporting patients for extended periods until recovery or transplantation.
• The evolution of ECLS technology over 40 years has led to significant improvements in safety, simplicity, and durability.

Purpose of the Study:

• To provide a comprehensive overview of the evolution of ECLS over the past four decades.
• To detail the application of ECLS in neonatal, pediatric, and adult populations.
• To describe the fundamental principles, circuit components, associated complications, and patient outcomes related to ECLS.

Main Methods:

• This review synthesizes information on the historical development and current state of ECLS.
• It examines trends in ECLS utilization across different age groups.
• The review includes a discussion of technological advancements and future directions in ECLS.

Main Results:

• Venoarterial (VA) and venovenous (VV) ECLS are the predominant modes of support.
• Neonatal respiratory ECLS use has decreased in the last 20 years.
• Adult respiratory ECLS use has increased, particularly following the 2009 H1N1 pandemic.

Conclusions:

• ECLS technology has advanced considerably, offering safer and more effective cardiorespiratory support.
• The application of ECLS varies significantly across pediatric and adult populations, with a notable rise in adult usage.
• Continued innovation in ECLS promises further improvements in patient outcomes for critical cardiorespiratory conditions.