الفهرس 
History of adult respiratory ECMO
Extra Corporeal MembraneOnly 14 pages are availabe for public view
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Abstract
Extracorporeal life support (ECLS) systems are
mechanical devices designed to temporarily support
the failing heart or lungs. They differ from
cardiopulmonary bypass systems used in the operating
room for very short-term support during surgery in
both their configuration and intent. The term ECMO is
often used interchangeably with ECLS, as we will use
it here, although it denotes a form of ECLS in which
the primary purpose is to provide blood oxygenation.
There are two anatomic approaches that are used to
implement ECMO: veno-arterial (VA) and venovenous (VV). Virtually all applications are variations
on these (Extracorporeal Life Support Organization,
2014).
ECMO is a high-risk and complex therapy that
may be considered for the sickest patients with ARF.
Potential indications for the use of ECMO include
severe ARF from: severe ARDS, status asthmaticus,
bridge to lung transplantation. ECMO should be
organized at regional and national levels to provide the
best care possible in high-volume, dedicated centers, because inappropriate use of ECMO may markedly
increase hospital costs and expose individual patients
to important risks. Referral to an expert ECMO center,
where ECMO is offered as part of a larger
management protocol for ARF, may be associated with
improved outcomes (Peek et al., 2009).
Networks of hospitals at the local, regional or
interregional level should be created around each
ECMO center located in tertiary referral hospitals.
Such networks have been successfully organized in the
UK (NHS, 2014), Italy and have been associated with
encouraging results for the treatment of the most
severe forms of influenza A (H1N1)–associated ARDS
(Patroniti et al., 2011). The feasibility of a networkwide system to evaluate the daily capacity for
receiving patients receiving ECMO at individual
centers was also demonstrated in Germany (WeberCarstens et al., 2013) and in France (Pham et al.,
2013).
Organization of ECMO programs on a regional or
national level is needed to provide the best, safest, and
most efficient care possible to the population. Local,
regional, or interregional networks of hospitals with a mobile ECMO team should ideally be created around
each ECMO center; such a system has recently
successfully been organized in a few countries (NHS,
2014).