Treatment of acute respiratory failure using extracorporeal membrane oxygenation (ECMO): the origins

Abstract

Extracorporeal membrane oxygenation (ECMO) applied to acute respiratory distress syndrome was clinically used as soon as the early seventies. A large randomized trial sponsored by the US National Institute of Health failed to show superiority over conventional treatment, i.e. mechanical ventilation with positive end-expiratory pressure. Mortality was high (95%) in both arms. Venoarterial bypass was the most commonly used route for perfusion at that time. Overall complications were common, some of them deadly: hemolysis, bleeding, hypo- or hyper-coagulation, superinfections, lower limb ischemia, lack of oxygenation of coronary and bronchial arteries… Large utilization stopped after the ECMO trial results were published in JAMA, in 1979. During the eighties, L. Gattinoni and collaborators renewed the rationale of extracorporeal support and started to implement what was called “low frequency positive pressure ventilation with extracorporeal CO₂ removal”, with much better results.