Cardiothoracic ICU, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore.
Intensive Care Med. 2012 Feb;38(2):210-20. doi: 10.1007/s00134-011-2439-2. Epub 2011 Dec 7.
Extracorporeal membrane oxygenation (ECMO) has been used in clinical medicine for 40 years but remains controversial therapy, particularly in adult patients with severe respiratory failure. Over the last few years, there have been considerable advances in extracorporeal technology and clinical practice, ushering in a new era of ECMO. Many institutions adopted ECMO as rescue therapy during the recent H1N1 influenza pandemic, reigniting the controversy.
Hollow-fibre oxygenators and Mendler-designed centrifugal pumps have replaced the old silicon oxygenators and roller pumps. The advantages of these novel systems and the principles that underlie their function are outlined. Advances in cannula technology allow greater ease of patient positioning, in some cases facilitating extubation and ambulation on ECMO. Improvements in ECMO circuitry have led to a reduction in heparin and blood product requirements, with consequently fewer complications. Greater understanding of severe acute respiratory distress syndrome has allowed clinicians to successfully support adults on ECMO for months at a time, as a bridge to either recovery or transplantation.
ECMO is safer, cheaper, and simpler than in previous eras. Both circuit and patient can be cared for by a single trained nurse. Additional prospective studies of ECMO for adult respiratory failure are underway. Contemporary ECMO in awake, potentially ambulant patients to provide short-term support for those with acute, reversible respiratory failure and as a bridge to transplantation in those with irreversible respiratory failure is now ready for widespread evaluation.
体外膜肺氧合（ECMO）在临床医学中已经使用了 40 年，但仍然是一种有争议的治疗方法，尤其是在患有严重呼吸衰竭的成年患者中。在过去的几年中，体外技术和临床实践取得了重大进展，迎来了 ECMO 的新时代。许多机构在最近的 H1N1 流感大流行期间将 ECMO 作为抢救疗法采用，再次引发了争议。
中空纤维氧合器和 Mendler 设计的离心式泵已经取代了旧的硅氧合器和滚柱泵。概述了这些新型系统的优点以及它们功能背后的原理。套管技术的进步允许更容易地对患者进行定位，在某些情况下可以在 ECMO 上更容易地拔管和行走。ECMO 电路的改进导致肝素和血液制品需求减少，并发症相应减少。对严重急性呼吸窘迫综合征的认识加深，使临床医生能够成功地在 ECMO 上支持成年人长达数月，作为恢复或移植的桥梁。
与以前的时代相比，ECMO 更安全、更便宜、更简单。单个经过培训的护士即可照顾电路和患者。正在进行更多针对成人呼吸衰竭的 ECMO 的前瞻性研究。目前，在清醒、有潜在活动能力的患者中使用 ECMO 来为急性、可逆性呼吸衰竭患者提供短期支持，并为不可逆性呼吸衰竭患者提供移植桥梁，现在已经可以广泛评估。
