ECMO-/ECLS

(Marcin) #1
Chapter 5
EXTRACORPOREAL MEMBRANE OXYGENATION/
EXTRACORPOREAL LUNG SUPPORT
Samir Gadepalli, MD
Ana Ruzic, MD
Ronald B. Hirschl, MD

I. Introduction
Extracorporeal life support (ECLS) denotes the use of prolonged
cardiopulmonary bypass, usually via extra-thoracic cannulation, in patients with
acute and reversible cardiac or respiratory failure, unresponsive to conventional
management.[ 1 ] Although extracorporeal membrane oxygenation (ECMO) is the
traditional term, ECLS is the current preferred mnemonic, since “life support”
encompasses functions other than “oxygenation”, including cardiac and
hemodynamic support, and carbon dioxide elimination.[ 2 ]
ECLS is not a therapeutic intervention; instead, it simply provides
cardiopulmonary support. The patient is spared the deleterious effects of high
airway pressures, higher fraction of inspired oxygen (FiO2), and perfusion
impairment, while pathophysiologic processes are allowed to heal, either
spontaneously or through therapeutic interventions.[ 3 ] Therefore, ECLS should
only be applied in settings where the pathophysiologic processes are considered
“reversible”. Goals of ECLS are to improve oxygen delivery, remove carbon
dioxide, and allow aerobic metabolism while the lungs rest.
Simply put, deoxygenated blood is removed from the patient into an external
membrane lung where oxygen is diffused into the blood and carbon dioxide is

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