Extracorporeal Membrane Oxygenation (ECMO)

Topic Information

Dear Colleagues,

During the last decades, extracorporeal membrane oxygenation (ECMO) has been used to describe the use of extracorporeal cardiopulmonary support in the ICU. Over the years the use of ECMO has expanded from neonates to adults and consists of pulmonary, cardiac, or combined support. Initially ECMO was applied when patients were on maximal conventional support and were considered to be moribund. The initial results in the neonatal population showed a mortality reduction from the predicted greater than 90% risk of mortality to a greater than 50% survival rate. In 1989 the Extracorporeal Life Support Organization (ELSO) was voluntarily formed to pool data and knowledge from all active ECMO centers.

Our Topic, together with the journals (Journal of Cardiovascular Development and Disease, Journal of Clinical Medicine, Medicina, Membranes, Advances in Respiratory Medicine) provide a platform for researchers around the globe to share the novel and cutting-edge works about extracorporeal membrane oxygenation. Topics include, but are not limited to, the following: extracorporeal CO₂ removal, extracorporeal life support, membrane biocompatibility, ECMO transportation, anticoagulation strategies, membrane imaging. Authors are invited to submit their latest results: original research papers, reviews (narrative, systematic), or case reports are welcome.

Prof. Dr. Patrick Honore
Prof. Dr. Isabelle Michaux
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Journal of Cardiovascular Development and Disease jcdd	2.4	2.6	2014	25.7 Days	CHF 2700
Journal of Clinical Medicine jcm	3.0	5.7	2012	16 Days	CHF 2600
Medicina medicina	2.4	3.3	1920	17.1 Days	CHF 2200
Membranes membranes	3.3	6.1	2011	14.9 Days	CHF 2200
Advances in Respiratory Medicine arm	1.8	2.6	1909	29.8 Days	CHF 1300

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Published Papers (7 papers)

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12 pages, 742 KiB  

Open AccessReview

Rising Above the Limits of Critical Care ECMO: A Narrative Review

by Pietro Bertini, Alberto Marabotti, Paolo Meani, Fabio Sangalli and Gianluca Paternoster

Medicina 2025, 61(2), 174; https://doi.org/10.3390/medicina61020174 - 21 Jan 2025

Viewed by 2124

Abstract

Extracorporeal membrane oxygenation (ECMO), an advanced life support method, was developed to treat severe cardiac and pulmonary failure in critically ill patients. ECMO was previously used to treat ARDS, cardiogenic shock, and after heart or lung transplant. It has since become a versatile [...] Read more.

Extracorporeal membrane oxygenation (ECMO), an advanced life support method, was developed to treat severe cardiac and pulmonary failure in critically ill patients. ECMO was previously used to treat ARDS, cardiogenic shock, and after heart or lung transplant. It has since become a versatile therapeutic and surgical tool. When conventional methods fail, this technique works well for high-risk procedures such as tracheal resections, ventricular tachycardia ablations, and complicated percutaneous coronary interventions. These uses demonstrate ECMO’s ability to oxygenate and stabilize the hemodynamics in challenging clinical circumstances. Clinical studies report survival rates exceeding 60% in ECMO-assisted thoracic surgeries, underscoring its efficacy in these settings. Recent advancements, such as portable ECMO systems and artificial intelligence-driven management tools, have further enhanced the safety and effectiveness of ECMO, enabling its use in diverse clinical environments. However, challenges remain, particularly in patient selection, resource allocation, and addressing ethical dilemmas. The integration of standardized protocols and technological innovations has mitigated complications such as vascular injury and infection, contributing to improved patient outcomes. This review examines ECMO applications and integration into multidisciplinary care, its configurations, and its growing role outside the intensive care unit in elective thoracic and cardiac surgery, trauma, and non-cardiac high-risk procedures. Full article

(This article belongs to the Topic Extracorporeal Membrane Oxygenation (ECMO))

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12 pages, 1591 KiB  

Open AccessArticle

Outcomes and Prognosis of COVID-19-Induced Adult Respiratory Distress Syndrome Patients Treated with Prolonged Veno-Venous Extracorporeal Membrane Oxygenation: A Retrospective Multicenter Study

by Amram Bitan, Nitzan Sagie, Eduard Ilgiyaev, Dekel Stavi, Maged Makhoul, Arie Soroksky, Yigal Kasif, Victor Novack and Ori Galante

J. Clin. Med. 2024, 13(23), 7252; https://doi.org/10.3390/jcm13237252 - 28 Nov 2024

Viewed by 693

Abstract

Background: Predicting whether extracorporeal membrane oxygenation (ECMO) treatment duration affects prognosis is important both medically and economically. Methods: We conducted a retrospective, multicenter study to better understand the outcomes of patients treated with veno-venous (VV) ECMO over a prolonged duration, analyzing data [...] Read more.

Background: Predicting whether extracorporeal membrane oxygenation (ECMO) treatment duration affects prognosis is important both medically and economically. Methods: We conducted a retrospective, multicenter study to better understand the outcomes of patients treated with veno-venous (VV) ECMO over a prolonged duration, analyzing data from the Israel ECMO registry. The study included all adult patients treated with VV-ECMO due to COVID-19-induced respiratory failure. The primary outcomes were survival rates up to 180 days from cannulation. Results: One hundred and eighty-eight patients were included in the study. The median age was 50 years (IQR 42, 50), and 69% were male. Patients were mechanically ventilated for a median of 2.5 days before cannulation (IQR 0.5, 5). The mean ECMO support duration was 29.9 days, with a maximal duration of 189.9 days. The survival rate for 180 days was 56%. We found no change in survival for patients on ECMO for 14, 28, or 56 days. Every day of mechanical ventilation before cannulation correlated with an 11% greater risk for prolonged ECMO treatment (p = 0.01). Conclusions: COVID-19-induced ARDS patients treated with VV-ECMO for prolonged duration had the same prognosis as those treated for short periods of time. The longer the duration of mechanical ventilation before ECMO cannulation, the higher the risk for prolonged ECMO treatment. Full article

(This article belongs to the Topic Extracorporeal Membrane Oxygenation (ECMO))

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12 pages, 642 KiB  

Open AccessArticle

Algorithm of High-Risk Massive Pulmonary Thromboembolism with Extracorporeal Membrane Oxygenation

by Cagdas Baran, Ahmet Kayan and Canan Soykan Baran

J. Clin. Med. 2024, 13(22), 6822; https://doi.org/10.3390/jcm13226822 - 13 Nov 2024

Viewed by 1154

Abstract

Objective: Massive pulmonary embolism (PE) remains a life-threatening condition, often leading to acute respiratory and cardiac failure. This study evaluates the role of extracorporeal membrane oxygenation (ECMO) as a supportive treatment for high-risk patients undergoing surgical pulmonary embolectomy or catheter-based thrombectomy. Methods [...] Read more.

Objective: Massive pulmonary embolism (PE) remains a life-threatening condition, often leading to acute respiratory and cardiac failure. This study evaluates the role of extracorporeal membrane oxygenation (ECMO) as a supportive treatment for high-risk patients undergoing surgical pulmonary embolectomy or catheter-based thrombectomy. Methods: Between January 2018 and December 2023, 27 patients with high-risk massive PE were treated at our center. Surgical embolectomy (n = 7) and catheter-based thrombectomy (n = 5) were performed, with ECMO support (veno-arterial [VA] or veno-arterial-venous [VAV]) initiated preoperatively, intraoperatively, or postoperatively, based on hemodynamic instability. ECMO was used as a bridge to recovery, and outcomes were assessed in terms of mortality, hemodynamic stabilization, and recovery. Results: Of the 27 patients, 20 were supported with ECMO, with 7 requiring VA-ECMO intraoperatively due to difficulties in weaning from cardiopulmonary bypass (CPB). Nine patients were later transitioned to VAV-ECMO due to Harlequin syndrome and persistent hemodynamic instability. The in-hospital mortality rate was 18.5% (n = 5), with survivors showing significant improvements in hemodynamic and biochemical parameters post-ECMO, including reduced lactate levels, improved right ventricular function, and the stabilization of mean arterial pressure. The mean follow-up time was 10.2 ± 3.9 months, with no late deaths or complications observed. Conclusions: ECMO provides effective life support in high-risk patients with massive PE who are undergoing surgical embolectomy or thrombectomy. It stabilizes hemodynamics, improves cardiac and pulmonary function, and facilitates recovery in critically ill patients. Further research is needed to refine patient selection, optimize ECMO timing, and assess long-term outcomes to determine its definitive role in the management of high-risk PE. Full article

(This article belongs to the Topic Extracorporeal Membrane Oxygenation (ECMO))

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11 pages, 233 KiB  

Open AccessArticle

Comparison of ECMO, IABP and ECMO + IABP in the Postoperative Period in Patients with Postcardiotomy Shock

by Cagdas Baran, Evren Ozcinar, Ahmet Kayan, Nur Dikmen, Canan Soykan Baran and Mustafa Bahadir Inan

J. Cardiovasc. Dev. Dis. 2024, 11(9), 283; https://doi.org/10.3390/jcdd11090283 - 8 Sep 2024

Cited by 1 | Viewed by 1840

Abstract

Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried [...] Read more.

Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried out a retrospective analysis that included 255 patients. Among them, 98 received IABP, 103 received VA-ECMO, and 54 received both VA-ECMO and IABP. Preoperative and postoperative assessments were carried out, including evaluations of left ventricular function and serum creatinine levels. Primary outcomes included 30-day survival and successful VA-ECMO weaning. Complications such as bleeding, sepsis, liver failure, wound infection, and peripheral ischemia were also assessed. Results: The weaning rate from VA-ECMO was significantly higher in the combined VA-ECMO and IABP group (81.4%) compared with the other groups (p = 0.004). One-year survival was also higher in the combined group (75.9%) (p = 0.002). Complications or renal function did not differ significantly among the groups. The primary indication for mechanical support was coronary artery bypass grafting. Conclusions: In conclusion, the combined use of VA-ECMO and IABP therapy led to improved weaning and survival rates without increasing the risk of complications. These findings suggest that a combined approach may be beneficial for selected patients with severe cardiac dysfunction post surgery. Full article

(This article belongs to the Topic Extracorporeal Membrane Oxygenation (ECMO))

10 pages, 1967 KiB  

Open AccessArticle

Vascular Complications in Patients with ECMO Support after Cardiac Surgery

by Cagdas Baran, Evren Ozcinar, Ahmet Kayan, Mehmet Cahit Saricaoglu, Ali Ihsan Hasde, Canan Soykan Baran, Ahmet Ruchan Akar and Sadik Eryilmaz

J. Clin. Med. 2024, 13(17), 5055; https://doi.org/10.3390/jcm13175055 - 26 Aug 2024

Cited by 1 | Viewed by 947

Abstract

Background: This study assessed vascular complications in patients who received extracorporeal membrane support following cardiac surgery. Methods: We included 84 post-cardiotomy patients who underwent extracorporeal membrane oxygenation (ECMO) from July 2018 to May 2022. Only patients connected to VA-ECMO (Veno-Arterial) via peripheral cannulation [...] Read more.

Background: This study assessed vascular complications in patients who received extracorporeal membrane support following cardiac surgery. Methods: We included 84 post-cardiotomy patients who underwent extracorporeal membrane oxygenation (ECMO) from July 2018 to May 2022. Only patients connected to VA-ECMO (Veno-Arterial) via peripheral cannulation were included in this study. Vascular complications were compared between those who had ECMO placed using the percutaneous technique (n = 52) and those who had it placed via femoral incision (n = 32). Results: The incidence of vascular thromboembolism was significantly higher in the percutaneous technique group compared with the open technique group (p < 0.05). Hematomas were also more frequent in the percutaneous technique group (p = 0.04). Conversely, bleeding and leakage were significantly more frequent in the open technique group (p = 0.04). There were no significant differences between the two groups in terms of wound infections or revisions in the inguinal area following ECMO removal. The mortality rate associated with vascular ischemia was 81.2%, while the overall in-hospital mortality rate was 60.7%. Conclusions: The open technique for ECMO placement may reduce the risk of thromboembolic events and hematomas compared to the percutaneous technique. However, it may be associated with a higher incidence of bleeding and leakage. Both techniques show similar outcomes in terms of overall mortality and wound infections. Full article

(This article belongs to the Topic Extracorporeal Membrane Oxygenation (ECMO))

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11 pages, 2945 KiB  

Open AccessArticle

Has Extracorporeal Gas Exchange Performance Reached Its Peak?

by Foivos Leonidas Mouzakis, Ali Kashefi, Flutura Hima, Khosrow Mottaghy and Jan Spillner

Membranes 2024, 14(3), 68; https://doi.org/10.3390/membranes14030068 - 17 Mar 2024

Cited by 1 | Viewed by 2089

Abstract

Extracorporeal gas exchange therapies evolved considerably within the first three–four decades of their appearance, and have since reached a mature stage, where minor alterations and discrete fine-tuning might offer some incremental improvement. A different approach is introduced here, making use of modern, purely [...] Read more.

Extracorporeal gas exchange therapies evolved considerably within the first three–four decades of their appearance, and have since reached a mature stage, where minor alterations and discrete fine-tuning might offer some incremental improvement. A different approach is introduced here, making use of modern, purely diffusive membrane materials, and taking advantage of the elevated concentration gradient ensuing from gas pressure buildup in the gas chamber of the oxygenator. An assortment of silicone membrane gas exchangers were tested in vitro as per a modified protocol in pursuance of assessing their gas exchange efficiency under both regular and high-pressure aeration conditions. The findings point to a stark performance gain when pressurization of the gas compartment is involved; a 40% rise above atmospheric pressure elevates oxygen transfer rate (OTR) by nearly 30%. Carbon dioxide transfer rate (CTR) does not benefit as much from this principle, yet it retains a competitive edge when higher gas flow/blood flow ratios are employed. Moreover, implementation of purely diffusive membranes warrants a bubble-free circulation. Further optimization of the introduced method ought to pave the way for in vivo animal trials, which in turn may potentially unveil new realms of gas exchange performance for therapies associated with extracorporeal circulation. Full article

(This article belongs to the Topic Extracorporeal Membrane Oxygenation (ECMO))

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11 pages, 1271 KiB  

Open AccessArticle

Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

by Lars Falk, Marika Lidegran, Sandra Diaz Ruiz, Jan Hultman and Lars Mikael Broman

J. Clin. Med. 2024, 13(4), 1113; https://doi.org/10.3390/jcm13041113 - 16 Feb 2024

Viewed by 1187

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is indicated for patients with severe respiratory and/or circulatory failure. The standard technique to visualize the extent of pulmonary damage during ECMO is computed tomography (CT). Purpose: This single-center, retrospective study investigated whether pulmonary blood flow (PBF) measured [...] Read more.

Background: Extracorporeal membrane oxygenation (ECMO) is indicated for patients with severe respiratory and/or circulatory failure. The standard technique to visualize the extent of pulmonary damage during ECMO is computed tomography (CT). Purpose: This single-center, retrospective study investigated whether pulmonary blood flow (PBF) measured with echocardiography can assist in assessing the extent of pulmonary damage and whether echocardiography and CT findings are associated with patient outcomes. Methods: All patients (>15 years) commenced on ECMO between 2011 and 2017 with septic shock of pulmonary origin and a treatment time >28 days were screened. Of 277 eligible patients, 9 were identified where both CT and echocardiography had been consecutively performed. Results: CT failed to indicate any differences in viable lung parenchyma within or between survivors and non-survivors at any time during ECMO treatment. Upon initiation of ECMO, the survivors (n = 5) and non-survivors (n = 4) had similar PBF. During a full course of ECMO support, survivors showed no change in PBF (3.8 ± 2.1 at ECMO start vs. 7.9 ± 4.3 L/min, p = 0.12), whereas non-survivors significantly deteriorated in PBF from 3.5 ± 1.0 to 1.0 ± 1.1 L/min (p = 0.029). Tidal volumes were significantly lower over time among the non-survivors, p = 0.047. Conclusions: In prolonged ECMO for pulmonary septic shock, CT was not found to be effective for the evaluation of pulmonary viability or recovery. This hypothesis-generating investigation supports echocardiography as a tool to predict pulmonary recovery via the assessment of PBF at the early to later stages of ECMO support. Full article

(This article belongs to the Topic Extracorporeal Membrane Oxygenation (ECMO))

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