Extracorporeal Membrane Oxygenation in Acute Respiratory Failure

Extracorporeal Membrane Oxygenation (ECMO) provides temporary life support by diverting venous blood through an artificial lung and returning oxygenated blood to the patient. In acute respiratory failure—most often in severe acute respiratory distress syndrome (ARDS)—veno-venous ECMO (VV ECMO) offers full respiratory support when conventional mechanical ventilation fails to maintain adequate gas exchange. Advances in pump and membrane technology have improved biocompatibility, reduced circuit‐related inflammation and enabled safer anticoagulation protocols. Patient selection is guided by severity of hypoxaemia, lung compliance and predicted reversibility, with early initiation linked to improved survival. Despite its life‐saving potential, ECMO carries risks including bleeding, thrombosis and device malfunction. Integration with adjunctive strategies such as prone positioning, ultra-protective ventilation and combined extracorporeal carbon dioxide removal (ECCO2R) aims to minimise ventilator-induced lung injury. Successful implementation relies on multidisciplinary teams, standardised training and vigilant monitoring. The global expansion of ECMO programmes during recent viral pandemics underscores its pivotal role in critical care and fuels ongoing research into optimised anticoagulation, circuit design and weaning protocols.

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Extracorporeal Membrane Oxygenation in Acute Respiratory Failure publication trend

The graph below shows the total number of articles in extracorporeal membrane oxygenation in acute respiratory failure across all publications each year (not limited to Nature Index journals).

Technical terms

Extracorporeal Membrane Oxygenation (ECMO): A life-support technique that oxygenates and removes carbon dioxide from blood via an external circuit.

Acute Respiratory Distress Syndrome (ARDS): A form of acute respiratory failure characterised by diffuse alveolar damage, severe hypoxaemia and reduced lung compliance.

Veno-Venous ECMO (VV ECMO): An ECMO configuration providing respiratory support by draining deoxygenated blood from a central vein and returning oxygenated blood to a central vein.

Extracorporeal Carbon Dioxide Removal (ECCO2R): A low-flow extracorporeal technique focused on removing carbon dioxide to allow very low tidal volume ventilation.

References

1. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Critical Care (2016).
2. Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation. Annals of Intensive Care (2016).
3. Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis. Critical Care (2021).
4. Technical Complications during Veno-Venous Extracorporeal Membrane Oxygenation and Their Relevance Predicting a System-Exchange – Retrospective Analysis of 265 Cases. PLOS ONE (2014).
5. Current Understanding of How Extracorporeal Membrane Oxygenators Activate Haemostasis and Other Blood Components. Frontiers in Medicine (2018).
6. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Annals of Intensive Care (2018).
7. Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Annals of Intensive Care (2017).
8. Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress syndrome. Critical Care (2016).