Editing Extracorporeal membrane oxygenation (section)

== Medical uses ==
[[Image:Ecmo schema-1-.jpg|thumb|ECMO sketch]]
[[Image:ECMO in H1N1 patient in Santa Cruz Hospital - Lisbon.jpg|thumb|ECMO circuit]]
[[File:Оксигенатор QUADROX компании MAQUET.jpg|thumb|A MAQUET [[hollow fiber membrane]] oxygenator]]
Guidelines that describe the indications and practice of ECMO are published by the [[Extracorporeal Life Support Organization]] (ELSO). Criteria for the initiation of ECMO vary by institution, but generally include acute severe cardiac or pulmonary failure that is potentially reversible and unresponsive to conventional management. Examples of clinical situations that may prompt the initiation of ECMO include the following:<ref>{{cite web |url=https://www.elso.org/Portals/0/IGD/Archive/FileManager/929122ae88cusersshyerdocumentselsoguidelinesgeneralalleclsversion1.3.pdf |title=General Guidelines for all ECLS Cases |work= Extracorporeal Life Support Organization |access-date=2015-04-15}}</ref>
 
* Hypoxemic [[respiratory failure]] with a ratio of arterial oxygen tension to [[fraction of inspired oxygen]] (PaO2/FiO2) of <100 mmHg despite optimization of the ventilator settings, including the fraction of inspired oxygen (FiO2), [[positive end-expiratory pressure]] (PEEP), and inspiratory to expiratory (I:E) ratio
* Hypercapnic respiratory failure with an arterial pH <7.20
* Refractory [[cardiogenic shock]]
* [[Thyroid storm]]<ref>{{Cite journal |last1=Amos |first1=Shoshana |last2=Pollack |first2=Rena |last3=Sarig |first3=Inon |last4=Rudis |first4=Ehud |last5=Hirshoren |first5=Nir |last6=Weinberger |first6=Jeffrey |last7=Arad |first7=Ariela |last8=Fischer |first8=Matan |last9=Talmon |first9=Aviv |last10=Stokar |first10=Joshua |date=May 2023 |title=VA-ECMO for Thyroid Storm: Case Reports and Review of the Literature |url=https://pubmed.ncbi.nlm.nih.gov/37245101/ |journal=The Israel Medical Association Journal |volume=25 |issue=5 |pages=349–350 |issn=1565-1088 |pmid=37245101}}</ref>
* [[Cardiac arrest]]
* Failure to wean from [[cardiopulmonary bypass]] after cardiac surgery
* As a bridge to either heart transplantation or placement of a [[ventricular assist device]]
* As a bridge to [[lung transplantation]]
* [[Septic shock]] is a more controversial but increasingly studied use of ECMO
* [[Hypothermia]], with a core temperature between 28 and 24&nbsp;°C and cardiac instability, or with a core temperature below 24&nbsp;°C.<ref>{{Cite book|url=https://www.nh.gov/safety/divisions/fstems/ems/advlifesup/patientcare.html|title=State of New Hampshire Patient Care Protocols v7|publisher=NH Medical Control Board|year=2018|location=New Hampshire|page=2.10}}</ref>

In those with cardiac arrest or cardiogenic shock, it is believed to improve survival and good outcomes.<ref>{{cite journal | vauthors = Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engström AE, Lagrand WK, Cherpanath TG, Driessen AH, de Mol BA, Henriques JP | title = Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis | journal = Intensive Care Medicine | volume = 42 | issue = 12 | pages = 1922–1934 | date = December 2016 | pmid = 27647331 | pmc = 5106498 | doi = 10.1007/s00134-016-4536-8 }}</ref> However, a recent clinical trial has shown that in patients with cardiogenic shock following acute myocardial infarction, ECLS did not improve survival (as measured via 30-day mortality); on the contrary, it resulted in increased complications (e.g., major bleeding, lower limb ischemia).<ref>{{cite journal | vauthors = Thiele H, Zeymer U, Akin I, Behnes M, Rassaf T, Mahabadi AA, Lehmann R, Eitel I, Graf T, Seidler T, Schuster A, Skurk C | title = Extracorporeal Life Support in Infarct-Related Cardiogenic Shock | journal = The New England Journal of Medicine | volume = 189 | issue = 14 | pages = 1286–1297 | date = October 2023 | doi = 10.1056/NEJMoa2307227 | pmid = 37634145 | s2cid = 261220088 }}</ref> This finding is corroborated by a recent meta-analysis <ref>{{cite journal | vauthors = Zeymer U, Freund A, Hochadel M, Ostadal P, Belohlavek J, Rokyta R, Massberg S, Brunner S, Lüsebrink E, Flather M, Adlam D, Bogaerts K, Banning A, Sabaté M, Akin I, Jobs A, Schneider S, Desch S, Thiele H | title = Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials | journal = The Lancet | volume = 402 | issue = 10410 | pages = 1338–1346 | date = October 2023 | doi = 10.1016/S0140-6736(23)01607-0 | pmid = 37643628 | s2cid = 265892649 | url = https://figshare.com/articles/journal_contribution/25240234 }}</ref> that used data from four previous clinical trials, indicating a need to reassess current guidelines for initiation of ECLS treatment.

===Use in COVID-19 patients===
Beginning in early February 2020, doctors in [[COVID-19 pandemic in China|China]] increasingly used ECMO as an adjunct support for patients presenting with acute viral pneumonia associated with [[Severe acute respiratory syndrome coronavirus 2|SARS-CoV-2]] infection ([[COVID-19]]) when, with [[Artificial ventilation|ventilation]] alone, the blood oxygenation levels still remain too low to sustain the patient.<ref name=":0">{{Cite web|url=http://www.xinhuanet.com/english/2020-02/15/c_138785933.htm |archive-url=https://web.archive.org/web/20200216094732/http://www.xinhuanet.com/english/2020-02/15/c_138785933.htm |url-status=dead |archive-date=February 16, 2020 |title=30 to 39 pct of severe COVID-19 patients discharged from Wuhan hospitals: official  |website=[[xinhuanet.com]] |access-date=2020-02-16}}</ref> Initial reports indicated that it assisted in restoring patients' blood oxygen saturation and reducing fatalities among the approximately 3% of severe cases where it was utilized.<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html|title=2019 Novel Coronavirus (2019-nCoV)|last=CDC|date=2020-02-11|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-02-16}}</ref>  For critically ill patients, the mortality rate reduced from around 59–71% with conventional therapy to approximately 46% with extracorporeal membrane oxygenation.<ref>{{cite journal | vauthors = Melhuish TM, Vlok R, Thang C, Askew J, White L | title = Outcomes of extracorporeal membrane oxygenation support for patients with COVID-19: A pooled analysis of 331 cases | journal = The American Journal of Emergency Medicine | volume = 39 | pages = 245–246 | date = January 2021 | pmid = 32487460 | pmc = 7256518 | doi = 10.1016/j.ajem.2020.05.039 |issn=0735-6757 | doi-access = free }}</ref> A March 2021 ''[[Los Angeles Times]]'' cover story illustrated the efficacy of ECMO in an extremely challenging COVID patient.<ref>{{Cite news | newspaper = LA Times | vauthors = Curwen T |title=She was dying of COVID-19. Her last hope was a device that would save or kill her | date = 3 March 2021 |url= http://enewspaper.latimes.com/infinity/article_share.aspx?guid=3ad3b194-c519-46b6-9de0-572e06df5fd3}}</ref> In February 2021, three pregnant Israeli women who had "very serious" cases of COVID-19 were given ECMO treatment and it seemed this treatment option would continue.<ref name="sbnp">{{cite news | vauthors = Ben-Nun S |title=Pregnant women must not get COVID vaccine in first trimester - Health Min. |url=https://www.jpost.com/israel-news/pregnant-women-must-not-get-covid-vaccine-in-first-trimester-health-min-657083 |publisher=The Jerusalem Post |date=4 February 2021}}</ref>

=== Outcomes ===
Early studies had shown survival benefit with use of ECMO for people in acute respiratory failure especially in the setting of [[acute respiratory distress syndrome]].<ref name="pmid9315812" /><ref name="pmid9310799" /> A registry maintained by ELSO of nearly 51,000 people that have received ECMO has reported outcomes with 75% survival for neonatal respiratory failure, 56% survival for pediatric respiratory failure, and 55% survival for adult respiratory failure.<ref>{{cite journal | vauthors = Thiagarajan RR, Barbaro RP, Rycus PT, Mcmullan DM, Conrad SA, Fortenberry JD, Paden ML | title = Extracorporeal Life Support Organization Registry International Report 2016 | journal = ASAIO Journal | volume = 63 | issue = 1 | pages = 60–67 | date = 2017-04-01 | pmid = 27984321 | doi = 10.1097/MAT.0000000000000475 | s2cid = 205758344 }}</ref> Other observational and uncontrolled clinical trials have reported survival rates from 50 to 70%.<ref name="pmid15383787"/><ref name="pmid19768656"/> These reported survival rates are better than historical survival rates.<ref name="pmid9351722"/><ref name="pmid9556124"/><ref name="pmid10598597"/> Even though ECMO is used for a range of conditions with varying mortality rates, early detection is key to prevent the progression of deterioration and increase survival outcomes.<ref name = "Lich_2004">{{cite book | vauthors = Lich B |title=The Manual of Clinical Perfusion |date=2004 |publisher=Perfusion.com |location=Fort Myers, Florida |isbn=978-0-9753396-0-2 |edition=2nd }}</ref>

In the [[United Kingdom]], veno-venous ECMO deployment is concentrated in designated ECMO centers to potentially improve care and promote better outcomes.