Extracorporeal membrane oxygenation (ECMO) is an invasive form of life support used in intensive care for neonatal, paediatric and adult patients with severe respiratory and or cardiac failure. The technique uses a modified cardiac bypass circuit where blood is drained from a central vein into an extracorporeal circuit, the blood is propelled by a pump into an oxygenator. The oxygenated blood is warmed by a heat exchanger before being returned to the patient either via a central vein (veno-venous (VV) ECMO) or via a central artery (veno-arterial (VA) ECMO). ECMO is an extracorporeal support which allows the lungs and/or heart to rest whilst providing oxygen delivery to the organs, carbon dioxide removal and supporting the circulation of blood to the body.

A key principle to understand is that ECMO is a supportive therapy which ‘buys time’ to allow the heart and/or lungs to recover. ECMO cannot fix an irreversible pathology such as end-stage chronic lung disease. Hence selecting patients with a potentially reversible pathology is key to the successful outcome for ECMO.

Another principle of ECMO is attention to detail and the careful daily clinical assessment of the patient including management of fluid balance, nutrition and early treatment of infection to maximize the chance of the patient weaning successfully off ECMO support.