الفهرس 
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Abstract
Extracorporeal membrane oxygenation (ECMO) is a type of prolonged mechanical cardiopulmonary support that is usually delivered in the intensive care unit. ECMO should only be performed in centers with the appropriate equipment and expertise.
We suggest that patients with severe, but potentially reversible, acute respiratory or cardiac failure that is unresponsive to conventional management be evaluated for ECMO if it is available within the medical center. For patients who are in a medical center that does not provide ECMO, transfer to another medical center to be evaluated for ECMO should be considered as soon as it is clear that the patient is not responding to management. The final decision should carefully weigh the survival rates for patients referred to an ECMO center versus the risk of transferring the patient.
There are two types of ECMO, venoarterial (VA) and venovenous (VV). VV ECMO is used in patients with respiratory failure, while VA ECMO is used in patients with cardiac failure.
Once it has been determined that ECMO will be initiated, the patient is anticoagulated with intravenous heparin. Cannulae are then inserted and the patient is connected to the ECMO circuit. The blood flow is increased until respiratory and hemodynamic parameters are satisfactory. Once the initial respiratory and hemodynamic goals have been achieved, blood flow is maintained, ventilator support is minimized, and vasoactive drugs are decreased to minimal levels. Frequent reassessment and adjustments are usually necessary.
The patient’s readiness for weaning from ECMO should be evaluated frequently. Prior to discontinuing ECMO permanently, one or more trials should be performed during which the patient is off ECMO. Such trials give the clinician to opportunity to determine whether conventional supportive care is sufficient for the patient.
Bleeding is the most common complication (30 to 40 percent) of ECMO. Thromboembolism and cannula complications are rare.