Extracorporeal life support

Extracorporeal life support (ECLS) is a method of cardiopulmonary bypass used to support patients with reversible respiratory insufficiency or cardiac failure. Previously, this type of support was termed extracorporeal membrane oxygenation. Because this technique aids not only in oxygenation but also in carbon dioxide elimination and hemodynamic support, it is more accurately termed ECLS. Although similar to cardiopulmonary bypass used during repair of cardiac anomalies, ECLS differs in several respects. In contrast to cardiac surgery bypass, which is carried out for several hours, ECLS may be maintained for several days to weeks with the purpose of allowing time for the lungs or heart to recover. The ECLS cannulas rarely are placed through a thoracotomy, but are usually inserted into the right common carotid artery and internal jugular vein via a cervical incision. In neonates, this procedure usually entails ligation of these vessels without reconstruction after decannulation. Heparinization during a 3-hour cardiac surgical procedure carries limited risk, whereas the ECLS patient assumes a significant risk of bleeding because he or she must be anticoagulated for the duration of the course on bypass. The most potentially devastating site of bleeding is intracranial, with subsequent neurologic damage. For all these reasons, ECLS is reserved for the most severely compromised patients. Given these caveats, this method of cardiopulmonary support has proved to be immensely successful when used correctly. This article discusses how the technique of ECLS arose, the specific patients for whom it is indicated, the methods by which it may be carried out, and the most recent data on this valuable therapy for neonatal, pediatric, and selected adult patients.