Clinical Review

Extracorporeal life support

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c5317 (Published 02 November 2010) Cite this as: BMJ 2010;341:c5317
  1. Alan M Gaffney, specialist registrar in anaesthesia13,
  2. Stephen M Wildhirt, professor of cardiothoracic surgery2,
  3. Michael J Griffin, consultant anaesthetist3,
  4. Gail M Annich, associate professor paediatric critical care medicine4,
  5. Marek W Radomski, professor of pharmacology1
  1. 1School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
  2. 2Department of Thoracic, Cardiac, and Vascular Surgery, University of Tübingen, Tübingen, Germany
  3. 3Mater Misericordiae University Hospital, Dublin, Ireland
  4. 4C S Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, Michigan 48109, USA
  1. Correspondence to: Marek W Radomski marek.radomski{at}tcd.ie

Summary points

  • Extracorporeal life support is a type of cardiopulmonary bypass that supports the lungs, heart, or both for days to weeks in patients in intensive care with reversible life threatening respiratory or cardiac disease

  • Venous-venous cannulation is used for respiratory failure and venous-arterial cannulation for cardiac failure (with or without respiratory failure)

  • Bleeding and thrombosis are the most common serious complications

  • Extracorporeal life support is used in children and adults; neonates with respiratory failure have the highest survival rates

  • Timing of extracorporeal life support is important—the specialist centre should be consulted early in the course of illness

Extracorporeal life support (ECLS) is a variation of cardiopulmonary bypass. Whereas cardiopulmonary bypass facilitates open heart surgery for a number of hours, extracorporeal life support maintains tissue oxygenation for days to weeks in patients with life threatening respiratory or cardiac failure (or both).

As technology advances, indications increase, and the numbers of specialist centres rise, more doctors are likely to find themselves assessing patients for early referral, discussing this support option with relatives, directly or indirectly managing patients on extracorporeal life support, and providing follow-up outpatient and community based care. During the recent H1N1 influenza A pandemic, one third of patients admitted to the intensive care unit with severe respiratory failure required extracorporeal life support.1

Evidence from case series, cohort studies, registry database analyses, and randomised controlled trials form the basis of this overview.

Sources and selection criteria

We searched PubMed, Embase, and the Cochrane Library for systematic reviews, randomised trials, large population based studies, case controlled studies, case series, scientific and clinical reviews, evidence based guidelines, and published consensus statements between 1996 and 2010. We used the search terms “extracorporeal membrane oxygenation”, “extracorporeal circulation”, and “extracorporeal life support”. We also consulted the registry database of the Extracorporeal Life Support Organization, personal databases, reference collections, and contemporary …

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