title: Extracorporeal membrane oxygenation for respiratory failure in adults.
abstract: OBJECTIVE
  This article reviews case series and trials that evaluated extracorporeal membrane oxygenation (ECMO) for respiratory failure and describes patient and circuit management in the modern era of ECMO support.
  
  
  RESULTS
  In recent years, pivotal progress has been made in the conception and construction of ECMO circuits. They are now simpler, safer, require less anticoagulation and are associated with fewer bleeding complications. The encouraging results of the efficacy and economic assessment of conventional ventilatory support versus ECMO for severe adult respiratory failure (CESAR) trial performed in the United Kingdom and good outcomes of patients who received ECMO as rescue therapy during the recent H1N1 influenza pandemic, in which the latest generation of ECMO technology was used, reignited interest in ECMO for severe acute respiratory distress syndrome (ARDS).
  
  
  CONCLUSIONS
  The latest generation of ECMO systems is more biocompatible, better performing and longer lasting. Although recent studies suggested that veno-venous ECMO might improve the outcomes of patients with ARDS, indications for ECMO use remain uncertain. Future trials of ECMO for severe ARDS should strictly control for standard-of-care mechanical ventilation strategies in the control group and early transportation on ECMO for patients in the intervention arm.
authors.affiliation: Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris, France. alain.combes@psl.aphp.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.forename: Vince
authors.initials: V
authors.lastname: Pellegrino
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D017410:Practice Guidelines as Topic; D011659:Pulmonary Gas Exchange; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*