ECMO : The Rescue Therapy

The extracorporeal support was first applied in 1972. The first randomized trial performed in ALI/ARDS patients showed a mortality equal to about 90% in patients treated with extra-corporeal support, not different to that of patients conventionally treated. In the eighties the extracorporeal CO2 removal was introduced, aiming at the lung rest.Different randomized studies did not show any survival benefit with extracorporeal CO2 removal support. It must be pointed out, however, that the technology available at that time was likely inadequate while, nowadays, it has been greatly improved and there are increasing numbers of reports describing simple forms of extracorporeal support, primarily aiming at CO2 removal. It is important to highlight that the need of ventilation is associated to the problem of VILI, which may be greatly reduced by extracorporeal supports. The recent H1N1 flu epidemics led to an epidemics of respiratory faiure with patients considered not safely ventilable with current clinical criteria (i.e. tidal volume 6-8 ml/Kg and plateau pressure below 30-35 cmH2O) leading to renewed interest for extracorporeal support with the publication of a great number of papers on the topic. Nowadays we believe that extracorporeal techniques should be applied only in experienced institutions, however we expect that in the next decade it will be applied as a routine maneuver for the treatment of patients with respiratory and circulatory failure.