The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)

Abstract

Since extracorporeal membrane oxygenation (ECMO) was introduced as a treatment modality for respiratory failure in 1972 by Hill et al.,[1] it has provided support to patients with inadequate oxygen delivery for days to weeks. Clinicians have used ECMO to increase oxygen delivery in severe lung disease, ineffective cardiac output from circulatory failure, or combined cardiopulmonary failure. ECMO has typically been applied in rescue situations that were refractory to conventional therapy.[2] Recently, researchers in the U.S., Germany, and Taiwan reported a rapid increase in the use of ECMO in their countries.[3-5] Diseases such as the H1N1 pandemic influenza,[6] the development of ECMO technology,[7] and the publication of randomized clinical trials have likely contributed to an increase in the use of ECMO.[8] In contrast to the growing worldwide use of ECMO, evidence of its use in critical care situations is still lacking.[9] In particular, there is not much evidence supporting ECMO use in adult patients with Acute Respiratory Distress Syndrome (ARDS) and there is a paucity of rigorous experiments on its use in these patients.[10] Only 4 randomized clinical trials on the use of extracorporeal life support in ARDS have been previously reported.[11-14] Most of the existing publications on ECMO use are observational studies of a retrospective review, clinical experiences, and clinical reports. Last year, the Korean Journal of Critical Care Medicine (KJCCM) published 11 papers which described the use of ECMO. Most of them were clinical reports of various clinical situations related to ECMO use, and one publication was an original article of a retrospective review. Publications such as clinical or case reports may not provide direct evidence, however they can provide important information and influence clinicians to consider new or different treatments in certain clinical situations. This issue of KJCCM includes two new case reports on the use of ECMO. The first case report describes a transient complication of ECMO that was corrected in a neonate,[15] and the second is a case on ECMO use in aspiration pneumonia in a single lung.[16] Both cases are conceivable situations for clinicians similar to previous case reports published in this journal. A key question is how to organize such case reports or series so that they provide findings that are close to evidence. To cite one example, ECMO complications can arise either from patient factors or ECMO circuit components. Due to the diversity in indi-