The amount of blood flow through the circuit and the fraction of oxygen delivered through the oxygenator are the main determinants of blood oxygenation and circulatory support. This pump then pushes the blood through a membrane oxygenator for gas exchange, and then the oxygenated blood is returned to the patient via an arterial cannula, resulting in complete respiratory and hemodynamic support. A venous cannula is used to drain deoxygenated blood into the pump. Other components include the pump electrical drive unit (controller), tubing, cannulas, and a heat exchanger to prevent temperature loss ( Fig. 6.2 ).Ĭurrent ecmo technologies used in cardiac supportĮCMO combines the use of a pump (ideally a centrifugal pump) for blood propulsion and a membrane oxygenator for gas exchange. Its ease of implantation and versatility have made ECMO the most widely used circulatory support system, with close to 2500 implants per year in the United States for cardiac support ( Fig. The ability of ECMO to provide complete cardiac support (left and right ventricle) as well as oxygenation has several advantages over some other percutaneous and surgically implanted temporary devices. The indications for adult ECMO have also expanded to include patients with various etiologies of cardiac failure, including acute myocardial infarction (AMI), end-stage dilated cardiomyopathy, refractory ventricular arrhythmias, acute myocarditis, the inability to wean from bypass after cardiac surgery, and cardiac arrest. ECMO has been successfully used as a bridge to cardiac recovery, a bridge to heart transplantation (BTT), a bridge to a more permanent left ventricular assist device (LVAD), a or as bridge-to-bridge (BTB). These complications, coupled with the availability of other circulatory support options, limited the use of ECMO, such that it was considered only occasionally as a salvage option in patients with very advanced cardiopulmonary failure.įortunately, with the development of polymethylpentene (PMP) oxygenators, bearing-less centrifugal pumps, and better cannula technology, there has been a rapid increase in the use of ECMO for cardiac support since 2009 ( Fig. Adults who were supported with ECMO had high rates of associated complications, including bleeding, thromboembolism, early oxygenator failure, disseminated intravascular coagulopathy, and systemic inflammatory response syndrome. Limitations of the pump and oxygenator technology limited prolonged and stable support. As a therapy for adult patients, ECMO use was limited to acute cardiogenic shock refractory to medical therapy or to patients with inability to come off CPB after complex cardiac operations. In the decades that followed, ECMO was rarely utilized in adults, but ECMO use was rapidly expanded to pediatric patients with congenital heart disease, meconium aspiration, or diaphragmatic hernia when no other options were available.
#Cardiohelp maquet trial#
This success resulted in a fervor of enthusiasm for the therapy, which was abruptly stunted 2 years later when a clinical trial only had 2 survivors out of 17 patients supported with ECMO. The first report of successful ECMO support was in 1972 in an adult patient with advanced respiratory failure as a consequence of severe pulmonary contusion.
CPB, Cardiopulmonary bypass ECMO, extracorporeal membrane oxygenation ELSO, Extracorporeal Life Support Organization LVAD, left ventricular assist device PMP, polymethylpentene PP, polypropylene Mag Lev, magnetic levitation TAH, total artificial heart. Timeline of the evolution of blood pumps for mechanical circulatory support.