Extra-corporeal membrane oxygenation (ECMO) is an innovative therapy that is used to support the physiologic needs of a patient during illnesses associated with acute severe respiratory and/or cardiac failure. ECMO is used in those life-threatening situations in which the oxygenation, ventilation, and circulatory support needs of the patient cannot be adequately maintained with a maximal conventional ventilator or pharmaceutical support. Essentially, ECMO is a simple pump circuit that can be used to support the role of failing lungs or hearts while therapies are aimed at organ recovery. While simple in concept and theory, this text illustrates the complexities associated with clinical use. The use of ECMO has evolved substantially overall the years–in part due to broader and growing applications, a better understanding of the technologies and how they can be used (especially in the context of long term human-ECMO circuit interactions), objective tools for patient selection, management protocols, and, most importantly, a growing body of evidence-based science and literature that demonstrates the effectiveness of this highly invasive, resource-intensive, and complex tool. The goal of this text is to draw from established thought leaders and experts around the world and present a comprehensive review of the rapidly-evolving and expanding literature regarding the spectrum of applications for ECMO. While by no means is this implied to be the final and exhaustive text on this topic, it does aim to be as comprehensive and up-to-date as possible which is, in itself, a challenge given how quickly this field is evolving. This text is aimed at students and providers, at all levels, who might have interest or be involved in the care of these critically ill patients. Chapters focus on how programs can be structured, the specific details of patient selection, management, and expanding roles of ECMO. Both basic and sophisticated concepts are presented with the goal that all may learn. We also present an objective assessment of some of the evolving challenges and limitations to ECMO in the context of the increased utilization and expansion of this therapy, combined with “sicker” patients, and the ongoing journey towards improved outcomes while offering a salvage therapy to patients who might otherwise die.
