Extracorporeal membrane oxygenation: unmet needs and perspectives.

Rheumatol Int

Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana City Research and Training Hospital, Adana, Türkiye.

Published: December 2024

AI Article Synopsis

  • ECMO is a critical lifesaving treatment for severe cardiovascular and respiratory failure, with an increasing range of applications, especially during the COVID-19 pandemic where it has been vital for patients with ARDS.
  • In pregnant women, ECMO can be used similarly to the general population, but healthcare providers must consider the health of both the mother and the fetus due to complicating factors of pregnancy.
  • The article discusses the importance of careful anticoagulation management in ECMO patients, summarizes how ECMO affects drug metabolism, and evaluates global practices, training, and rehabilitation needs for ECMO survivors to enhance their recovery and quality of life.

Article Abstract

Extracorporeal Membrane Oxygenation (ECMO) has become an essential lifesaving intervention for individuals with severe cardiovascular and respiratory failure. Its application is expanding across several therapeutic contexts, surpassing conventional indications. The COVID-19 pandemic has significantly stressed worldwide health systems to manage acute respiratory failure. ECMO has been employed as a vital intervention, particularly for patients with severe COVID-19-induced acute respiratory distress syndrome (ARDS). ECMO is applicable throughout pregnancy. The principal indications for ECMO in pregnant women align with those in the general population. However, pregnancy complicates issues, necessitating consideration of both mother's and infant's well-being. Patients with systemic rheumatic diseases are prone to experience life-threatening complications. While a majority of these patients respond to immunosuppressive drugs, a small percentage suffer organ failure and may benefit from ECMO as a bridge to recovery. The article addresses coagulation therapies, highlighting the necessity of precise anticoagulation to avert both bleeding and thrombosis, particularly in patients requiring extended ECMO support. Additionally, the pharmacokinetics of antibiotics in ECMO patients are summarized, including the influence of the ECMO circuit on drug metabolism. Survey-based research offers valuable insights into ECMO use, procedures, and challenges. The paper evaluates current survey-based research and ECMO guidelines, highlighting clinical practice, training, and resource availability discrepancies across ECMO centers globally. Particular focus is placed on the rehabilitation requirements of ECMO survivors, acknowledging the importance of early mobilization and post-discharge care in improving long-term outcomes and quality of life.

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Source
http://dx.doi.org/10.1007/s00296-024-05732-zDOI Listing

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