Extracorporeal membrane oxygenation as rescue therapy for severe hypoxemic respiratory failure

ECMO has been used for more than 50 years as salvage therapy for patients with severe cardiopulmonary failure that is refractory to conventional treatment. In the late 1930s, John Gibbon (1), after witnessing a young patient’s death from a pulmonary embolism, began experimenting with extracorporeal blood-flow circuits that might temporarily support cardiorespiratory function. He hypothesized that an effective circuit might allow surgical thrombectomy of massive life-threatening emboli and even potentially allow surgery on the heart. After two decades of painstaking experimentation, Gibbon performed the first successful operation using such an extracorporeal circuit, to close a large atrial septal defect in an 18-year-old woman (2). However, his device, and similar ones of that era, required direct contact between blood and gas, which damaged blood constituents and thus could be used for only a few hours at a time. An interesting observation published in 1944 helped to solve that problem and led to the next generation of extracorporeal oxygenators: Kolff and colleagues (3) observed that blood was oxygenated as it crossed the cellophane chambers in their first artificial kidney machine. By 1956, Clowes et al. (4) had developed a unique oxygenator with a membrane that separated the gaseous and liquid phases, allowing lengthier extracorporeal circulation of blood. This device was initially used as a “cardiopulmonary bypass” in the burgeoning field of open heart surgery (5)