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ECMO for Adult Respiratory Failure: Current Use and Evolving Applications

Agerstrand, Cara L.*; Bacchetta, Matthew D.; Brodie, Daniel*

doi: 10.1097/MAT.0000000000000062
Review Article

Extracorporeal membrane oxygenation (ECMO) is increasingly being used to support adults with severe forms of respiratory failure. Fueling the explosive growth is a combination of technological improvements and accumulating, although controversial, evidence. Current use of ECMO extends beyond its most familiar role in the support of patients with severe acute respiratory distress syndrome (ARDS) to treat patients with various forms of severe hypoxemic or hypercapnic respiratory failure, ranging from bridging patients to lung transplantation to managing pulmonary hypertensive crises.

The role of ECMO used primarily for extracorporeal carbon dioxide removal (ECCO2R) in the support of patients with hypercapnic respiratory failure and less severe forms of ARDS is also evolving. Select patients with respiratory failure may be liberated from invasive mechanical ventilation altogether and some may undergo extensive physical therapy while receiving extracorporeal support. Current research may yield a true artificial lung with the potential to change the paradigm of treatment for adults with chronic respiratory failure.

From the *Department of Medicine, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York; and Department of Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.

Submitted for consideration January 24, 2014; accepted for publication in revised form February 7, 2014.

Disclosures: The authors have no conflicts of interest to report.

Reprint Requests: Cara L. Agerstrand, MD, Department of Medicine, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, 622 West 168th Street, PH 8–101, New York, NY 10032. Email: ca2264@columbia.edu.

Copyright © 2014 by the American Society for Artificial Internal Organs