What is ECMO treatment?
Extracorporeal membrane oxygenation (ECMO) is a form of extracorporeal life support (ECLS). It provides temporary respiratory and/or systemic circulatory support by enriching deoxygenated blood with oxygen and removing carbon dioxide. The ECLS system includes cannulas for vascular access, a blood pump and an oxygenator for gas exchange. Venovenous ECMO mainly supports respiratory functions, while venoarterial ECMO supports both, respiratory and circulatory functions.
ECMO treatment provides a bridge to either natural organ recovery or long-term devices or transplantation. Although it is able to temporarily support cardiorespiratory function, it’s not a cure for the underlying disease. Warren Zapol, one of the fathers of respiratory ECMO, stated in an editorial in the “New England Journal of Medicine” in 1972: the goal of ECLS is to “buy time” while maintaining adequate tissue perfusion.[1]
The origins of ECLS come from cardiac surgery and from the heart-lung machine. Nevertheless, at least until a few years ago, ECLS was mainly used and researched for severe respiratory failure.[2]
Neonatal and pediatric extracorporeal life support
Our pediatric ECMO treatments and products are focused specifically on pediatric and neonatal patients. We offer products designed for this young and diverse group of patients with our Novalung kits product portfolio.
Synchronized cardiac support
An innovative VA ECMO treatment is our synchronized cardiac support (SCS). The vision of SCS is to bridge the gap between physiology and mechanical circulatory support by adapting to the patient’s heart rhythm via an ECG-triggerd pulsatile flow.
Clinical trials to generate evidence for SCS treatment are scheduled. Data from preclinical studies is available.[3-8]
ECCO2R: Extracorporeal carbon dioxide removal
A treatment similar to ECMO, yet focusing only on CO2 removal is a treatment called extracorporeal carbon dioxide removal (ECCO₂R). ECCO₂R is used in critically ill patients suffering from hypercapnia or COPD, in order to support non-invasive ventilation and avoid escalation to more aggressive treatments (e.g. intubation for mechanical ventilation, VV ECMO, etc.).[9,10]
MultiECCO2R: Extracorporeal CO2 removal in combination with multiFiltratePRO and multiFiltrate
Kidneys and lungs are deeply affiliated with each other and if harmed, their failure strongly influence one another.[11] Many patients who have acute respiratory distress syndrome (ARDS) and therefore require mechanical ventilation also experience acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT). For these patients, the combination of extracorporeal carbon dioxide removal (ECCO2R) and CKRT in a single extracorporeal circuit may represent an alternative therapeutic option.[12]
The multiECCO2R gas exchanger enables the delivery of low-flow ECCO2R in combination with CKRT simultaneously on a single therapy system[13] using one vascular access.
[1] Zapol, W. M. & Kitz, R. J. (1972). Buying time with artificial lungs. N Engl J Med, 286(12), 657-658
[2] Scaravilli, V. et al. (2014). Basic Aspects of Physiology During ECMO Support. In F. Sangalli et al. (editors), ECMO – Extracorporeal Life Support in Adults, Milano, Italy: Springer
[3] Ostadal, P. et al. (2018). Electrocardiogram-synchronized pulsatile extracorporeal life support preserves left ventricular function and coronary flow in a porcine model of cardiogenic shock. PLoS One, 13(4), e0196321
[4] Cremers, B. et al. (2015). Pulsatile venoarterial perfusion using a novel synchronized cardiac assist device augments coronary artery blood flow during ventricular fibrillation. Artif Organs, 39(1), 77-82
[5] Wang, S. et al. (2018). Impact of Different Perfusion Modalities on Coronary and Carotid Blood Flow Velocities in an Adult ECLS Swine Model . Artif Organs, 42(9), 918-921
[6] Wang, S. et al. (2015). In Vivo Hemodynamic Performance Evaluation of Novel Electrocardiogram-Synchronized Pulsatile and Nonpulsatile Extracorporeal Life Support Systems in an Adult Swine Model. Artif Organs, 39(7), E90-E101
[7] Zhang, Y. et al. (2021). Pulsatility protects the endothelial glycocalyx during extracorporeal membrane oxygenation. Microcirculation, 28(7), e12722
[8] Li, G. et al. (2021). The Pulsatile Modification Improves Hemodynamics and Attenuates Inflammatory Responses in Extracorporeal Membrane Oxygenation. J Inflamm Res, 14, 1357-1364
[9] Combes, A. et al. (2020). ECCO2R therapy in the ICU: consensus of a European round table meeting. Crit Care, 24(1), 490-500
[10] Staudinger, T. (2020). Update on extracorporeal carbon dioxide removal: a comprehensive review on principles, indications, efficiency, and complications. Perfusion, 35(6), 492-508
[11] Singbartl, K. et al. (2011). Renal-pulmonary crosstalk. Contrib Nephrol, 174, 65-70
[12] Jacobs, R. et al. (2020). Extracorporeal Carbon Dioxide Removal During Continuous Renal Replacement Therapy as Adjunctive Therapy. Respir Care, 65(4), 517-524
[13] Husain-Syed, F. et al. (2020). Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome. Front Med, 7, 598379