**2. Extracorporeal life support (ELS) or extracorporeal membrane oxygenation (ECMO)**

Extracorporeal membrane oxygenation (ECMO) is a device that allows temporary support in pulmonary and/or cardiac failure refractory to conventional medical management [19]. It mainly consists of a blood pump, oxygenator, drainage and returns cannulae and arterial and venous access points (**Figure 1**). The blood pump propels the blood to the oxygenator membrane where the gas exchange between the patient's blood and the gas mixture of the device happens.

The ECMO has three main configurations depending on the access sites used: veno-venous (VV) ECMO, peripheral veno-arterial (VA) ECMO and central VA

#### **Figure 1.**

*A diagram demonstrating the components of an extracorporeal membrane oxygenation device [19]. (The figure is shared through the CC BY 4.0 according to the original article).*

*Extracorporeal Membrane Oxygenation for the Support of Adults with Acute Myocarditis DOI: http://dx.doi.org/10.5772/intechopen.109313*

**Figure 2.**

*A diagram demonstrating the most common peripheral VA ECMO configuration [19]. (The figure is shared through the CC BY 4.0 according to the original article).*

ECMO. In VV ECMO, veins are used as both access sites with the purpose of supporting mainly the respiratory system. In this chapter, we will not focus on this configuration.

In VA ECMO, an artery and a vein are used as access sites. In central VA ECMO, the drainage cannula can be inserted directly into the right atrium, and the return cannula into the ascending aorta. On the other hand, in the peripheral VA ECMO, the drainage cannula is usually inserted into the femoral vein and the return cannula into the femoral artery (**Figure 2**). In this configuration, the patient's respiratory and circulatory systems are both supported essentially bypassing the heart and lungs providing oxygenated blood to peripheral organs. The heart still pumps blood up to the descending aorta depending on its systolic function.

The main complications of ECMO consist of device thrombosis, bleeding (access site, gastrointestinal or intracranial due to anticoagulation), acute kidney injury, limb ischemia (in peripheral configuration) and infection.
