Contents



Preface

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), has evolved from a salvage form of life support, used only in cases in which all other therapies have failed, to a mainstream therapy for patients experiencing acute cardiac and/or respiratory failure. Initial experiences were associated with poor outcomes and few survivors. Challenges to success included difficulties in optimal patient selection, crudely designed and implemented technologies, an unclear understanding of the relationship between the patient and the extracorporeal circuit, lack of management guidelines, and difficulties in managing complications and guiding patients. However, over the past 20−30 years, there has been a growing recognition of the potentially life‐saving benefits of the role of extracorporeal support in allowing the failing heart/lungs to heal, possibly allowing for recovery or serving as a bridge to more definitive end‐organ replacement therapy such as ventricular assist devices or transplantation. This evolution has reflected a long journey, one that continues to evolve in part due to the hard work, dedication, and overall commitment of those who recognize the tremendous potential of ECMO to bring hope and restore

ECMO is a rapidly evolving and extremely complex technology. With a better understanding of the technology, the indications for support, patient selection, surgical approach, and ECMO management, the outcomes will continue to improve.

Developing a comprehensive "ECMO team" is the first step in building a successful program. This team must be prepared to initiate therapy at any time and in any setting, from those as controlled as an operating room to those as chaotic as an emergency room. While the specific members of the team might vary from program to program, there are several key features that must be established in advance. It is well recognized that effective teams must communicate and work well together. There must be uniform trust and a collective value attached to the expertise that each member brings to the bedside. Additionally, there must be a willingness to embrace the concepts of crew resource management (CRM). The foundation of CRM is that every member of the team has a voice and that each voice is valued and respected. All members of the team must be encouraged, if not empowered, to speak up, particularly when there are safety concerns. In the context of an ECMO team, membership

This book discusses general clinical topics related to the specifics of therapy. There are chapters on cardiogenic shock, severe acute respiratory distress syndrome, and generalized applications for longer-term support. The book also addresses the fundamental differences between veno-veno ECMO (VV-ECMO) for pulmonary support and veno-arterial ECMO (VA-ECMO) for cardiac or cardiopulmonary support. This

life to those who would otherwise die.

must include all ECMO-related disciplines.
