Contents



Preface

Extracorporeal life support or extracorporeal membrane oxygenation (ECMO), as it is often known, continues to evolve into an effective therapy for managing patients who present, regardless of etiology, with acute severe cardiogenic shock and/or respiratory therapy. Previously, ECMO was thought to be a salvage therapy to be considered when all other conventional therapies had failed. However, with evolving guidelines, protocols, experiences, and tools to assist in patient selection, management, and various aspects of clinical (and administrative) decision making, ECMO has evolved into a mainstream therapy. With this evolution, outcomes have improved and overall, teams have become much more effective and efficient with regard to developing a structured "ECMO program." However, with thousands of cases being performed each year and with rapidly evolving technology along with an exponential growth of knowledge in this field, it is clear that there is still much to learn and understand. The technology is costly, not always readily available, and often very resource intensive typically requiring very advanced specialty training of all involved providers. It is promising that there has also been an evolution of case reports, case series, large institutional experiences, meta-analyses, and even randomized trials in this area to help support clinical application and decision making. Hopefully, this text—along with the previous volumes in this area—will continue to add to the literature on this topic in a meaningful way to help programs grow and outcomes

As experience grows, one thing that remains clear is that therapy must be initiated early, and having a well-structured and integrated clinical management team is critical to program success and good outcomes. Starting therapy before the development of irreversible end-organ damage is paramount. With a better understanding of the nuances of patient selection and management, protocols can be developed to aid those physicians and providers who are often faced with major decisions in which time is of the essence. Ethical (and social) implications cannot be overstated. While ECMO is often considered, along with many other therapies in healthcare currently, as a salvage option to potentially provide some hope for an actively dying patient, the concepts of futility, palliative care, and end-of-life must be considered. ECMO must not be considered as a "bridge to nowhere"—implying a final major intervention to avoid difficult conversations regarding the reality that

Without doubt, as this text will hopefully illustrate and educate, ECMO continues to evolve into an extremely important, powerful, and effective clinical tool, and

improve.

everyone at some point will die.
