Extracorporeal Membrane Oxygenation: Types, Medical Uses and Complications



Series: Medical Procedures, Testing and Technology
BISAC: MED003040

Extra-corporeal membrane oxygenation (ECMO) is an innovative therapy that is used to support the physiologic needs of a patient during illnesses associated with acute severe respiratory and/or cardiac failure. ECMO is used in those life-threatening situations in which the oxygenation, ventilation, and circulatory support needs of the patient cannot be adequately maintained with a maximal conventional ventilator or pharmaceutical support. Essentially, ECMO is a simple pump circuit that can be used to support the role of failing lungs or hearts while therapies are aimed at organ recovery. While simple in concept and theory, this text illustrates the complexities associated with clinical use. The use of ECMO has evolved substantially overall the years–in part due to broader and growing applications, a better understanding of the technologies and how they can be used (especially in the context of long term human-ECMO circuit interactions), objective tools for patient selection, management protocols, and, most importantly, a growing body of evidence-based science and literature that demonstrates the effectiveness of this highly invasive, resource-intensive, and complex tool.

The goal of this text is to draw from established thought leaders and experts around the world and present a comprehensive review of the rapidly-evolving and expanding literature regarding the spectrum of applications for ECMO. While by no means is this implied to be the final and exhaustive text on this topic, it does aim to be as comprehensive and up-to-date as possible which is, in itself, a challenge given how quickly this field is evolving.

This text is aimed at students and providers, at all levels, who might have interest or be involved in the care of these critically ill patients. Chapters focus on how programs can be structured, the specific details of patient selection, management, and expanding roles of ECMO. Both basic and sophisticated concepts are presented with the goal that all may learn. We also present an objective assessment of some of the evolving challenges and limitations to ECMO in the context of the increased utilization and expansion of this therapy, combined with “sicker” patients, and the ongoing journey towards improved outcomes while offering a salvage therapy to patients who might otherwise die.

Table of Contents

Table of Contents


Chapter 1. Administrative and Clinical Steps to ECMO Program Development
(Dianne McCallister, Matthew Libby, Linda Pilon, Jennifer Hanna and Michael S Firstenberg, Diagnosis Well, Greenwood Villiage, CO, USA, and others)

Chapter 2. Salvage Therapies in ARDS
(Patrick Jenkins, Sara Shahidm and Chakradhar Kotaru, Department of Internal Medicine, Health One/Sky Ridge, Parker, CO, USA, and others)

Chapter 3. Anticoagulation Practices during ECMO
(Pawel Martinka, Michael C. Sklar and C. David Mazer, Department of Anesthesia, St. Michael’s Hospital, Unity Health Toronto, Canada, and others)

Chapter 4. Anticoagulation Pharmacotherapy in ECMO
(Craig J. Beavers and H. Andrew Wilsey, Department of Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA, and others)

Chapter 5. Direct Thrombin Inhibitor Use during Extracorporeal Membrane Oxygenation
(Michael Colin Mowrer, Lakshmi Raman and Ali McMichael, Division of Pediatric Critical Care, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA, and others)

Chapter 6. Cannulation Pitfalls in ECMO
(Nkosi Alvarez, Lydia McDermott and Hitoshi Hirose, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA)

Chapter 7. Total Percutaneous Approach in Peripheral VA-ECMO: How to Cannulate and Decannulate the Arterial Ecmo Catheter and the Distal Perfusion Catheter
(S. Y. Au and G. W. Y. Ng, Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China)

Chapter 8. Blood Management for Adult ECMO/ECLS Patients
(Serdar Gunaydin, Emre Kulahcioglu and Kevin McCusker, Department of Cardiovascular Surgery, City Hospital, University of Health Sciences, Ankara, Turkey, and others)

Chapter 9. Blood Purification Therapy in Patients Treated with Extracorporeal Membrane Oxygenation
(Federico Pappalardo, Andrea Montisci and Letizia Bertoldi, Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, Palermo, Italy, and others)

Chapter 10. Multidisciplinary Team-Based Management of Cardiogenic Shock
(Alexander G. Truesdell, Mehul Desai, Aaron Bagnola, Erik Osborn, Carolyn Rosner, Ramesh Singh, Shashank Sinha, Daniel Tang, Behnam Tehrani, Timothy S. Welch, Charles Murphy and Wayne Batchelor, Virginia Heart, Falls Church, VA, USA, and others)

Chapter 11. Post-Cardiotomy Extracorporeal Membrane Oxygenation
(Edgar Aranda-Michel, Derek Serna-Gallegos, Arman Kilic and Ibrahim Sultan, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA)

Chapter 12. Extracorporeal Cardiopulmonary Resuscitation and Veno-Arterial ECMO in Trauma
(Vitali Karaliou, Michael H. Hines, Jeremy W. Cannon, Leopoldo C. Cancio and Andriy I. Batchinsky, Trauma Center and Department of Surgery, St. Luke’s University Health Network, Bethlehem, PA, USA, and others)

Chapter 13. ECMO and Lung Transplantation
(Mauricio Villavicencio, Masaki Funamoto, Asishana Osho, Nathaniel Langer and Gaston Cudemus, Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA, and others)

Chapter 14. Is There Any Role for Extra Corporeal Carbondioxide Removal?
(Harlinde Peperstraete, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, and others)

Chapter 15. Extracorporeal Membrane Oxygenation (ECMO) as a Bridge to Durable Mechanical Assist Device or Heart Transplantation
(Nicholas Hess and Arman Kilic, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA)

Chapter 16. ECMO as a Bridge to Left Ventricular Assist Device Implantation
(Amit Pawale and Duc Thinh Pham, Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA)

Chapter 17. ECMO as a Bridge to Heart Transplantation
(Eriberto Michel and Duc Thinh Pham, Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA)

Chapter 18. Extracorporeal Membrane Oxygenation in Neonatal and Pediatric Patients
(Tracy R. Geoffrion and Stephanie Fuller, Division of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA, and others)


About the Editor
Dr. Michael S. Firstenberg is a board-certified thoracic surgeon. He is the current Director of Research and Special Projects for the William Novick Global Cardiac Alliance. Previously, he was Chief of Cardiothoracic and Vascular Surgery at the Medical Center of Aurora and Rose Hospitals. He currently holds appointments in the Colleges of Medicine and Graduate Studies at Northeast Ohio Medical University. He attended Case Western Reserve University Medical School, received his General Surgery training at University Hospitals in Cleveland, and completed Fellowships at The Ohio State University (Thoracic Surgery) and The Cleveland Clinic (Surgical Heart Failure). He is an active member of the Society of Thoracic Surgeons (STS), American Association of Thoracic Surgeons (AATS), the American College of Cardiology (ACC), and the American College of Academic International Medicine (ACAIM – for which he is a Founding Fellow and President-elect). He currently serves on several professional society committees. He is the author of well over 200 peer-reviewed manuscripts, abstracts, and book chapters. He has edited several textbooks on topics ranging from Medical Leadership, Patient Safety, Endocarditis, and Extra-Corporeal Membrane Oxygenation – all of which include topics that he has lectured on world-wide.

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