**Michael S. Firstenberg, MD FACC FAIM**

Chief, Cardiothoracic and Vascular Surgery, Director, Adult ECMO Program, Associate Professor of Surgery and Integrative Medicine (Adjunct), Graduate Adjunct Faculty, College of Graduate Studies, Northeast Ohio Medical Universities, Rootstown, Ohio, USA

> Teaching Faculty, The Rocky Vista University, Parker, Colorado, USA

> > **1**

Section 1

Introduction

The Medical Center of Aurora and Rose Hospitals, Aurora, CO, USA

Section 1 Introduction

**3**

selected patients.

**Chapter 1**

**1. Introduction**

therapy to optimize outcomes [3].

Introductory Chapter: ECMO –

This text is now the third volume in a series of books focused on extracorporeal

As the indications for therapy evolve, there continues to be unusual and challenging clinical situations that deserve special attention for many reasons. For example, the chapter by Professor Nandini highlights the very complex issue that is becoming more common—the role of ECMO as a bridge to transplant. It was only a few years ago (and illustrated in the previous texts in this series) that the concept of ECMO as bridge to transplant was discouraged and difficult to justify due to the risks, concerns of limited resource allocation, and technical difficulties to a concept and management pathway that is routinely considered and offered to

Additional chapters focus on the growing literature and experiences in other specific disease state or clinical situations for which ECMO might be considered.

membrane oxygenation (ECMO) and extracorporeal life support (ECLS) [1]. With each volume, it becomes clearer that there has been a rapid evolution in the technology and the applications of it with regard to indications, management, outcomes, and the challenges in offering a very resource-intensive (and expensive) therapy in which the overall benefits are still questioned. Nevertheless, without a doubt, there has been an ongoing evolution of the use of ECMO as a salvage therapy offered only in extreme and potentially inherently futile cases, to now a mainstream therapy that can be routinely offered in well-defined cases of acute cardiac and respiratory failure. Early experiences resulted in few survivors and poor outcomes, but the reasons for this were clearly complex and multifactorial etiologies [2]. The development of more advanced pumps and circuits, better resources and guidelines for patient selection and management, and a broader understanding of the complex interactions between humans and an extracorporeal pump circuit for longer periods of time all have contributed to the advances in ECMO as an appropriate and reasonable therapy—even, as some would debate, standard of care for acute respiratory failure and/or cardiogenic shock. As these three volumes illustrate, over the years, there has been tireless improvements in all aspects of the use of ECMO. However, as the chapters in this text clearly illustrate, there is still much to be learned and understood. Challenges remain as clinicians continue to push the envelope of this technology to better define a patient population that might benefit from ECMO and how to apply and manage a very complex

Rapidly Evolving Technology,

Expanding Indications, and

*Michael S. Firstenberg and Jennifer M. Hanna*

Growing Challenges
