Lung Rescue and ECMO

Extracorporeal membrane oxygenation (ECMO) has been used for acute lung rescue in trauma patients since the 1970s. Indeed, the first documented use of ECMO in an adult was for acute respiratory failure in a polytrauma patient who ultimately recovered. Over the past five decades, there have been numerous advances in the management of acute respiratory failure including refined ventilatory approaches, use of pulmonary vasodilators, and prone positioning, among others. However, the mortality for patients with severe acute respiratory failure refractory to conventional management remains very high. Over the past decade, though, improvements in ECMO technology and a better understanding of the role of ECMO in severe acute respiratory failure have enabled the more routine use of ECMO for lung rescue in patient populations including trauma patients. The following chapter reviews ECMO origins, ECMO modality fundamentals, acute respiratory distress syndrome (ARDS) current knowledge, indications for ECMO rescue or support for injury-related as well as non-injury related ARDS, and elements of daily ECMO management for the bedside intensivist and care team.