There is widespread uptake of ECMO into intensive care medicine practice despite limited high-level evidence showing a survival benefit. Providing temporal organ support in selected patients however, is undoubtedly recognised as life-saving. The challenge remains to provide timely initiation of this technology in the appropriate critically ill patients without neglecting less invasive evidence-based intensive care treatments.
ECMO should be considered whenever a young patient (< 65 years of age) acutely deteriorates with potentially reversible cardiac and/ or respiratory failure despite optimal conventional treatment. The patient should ideally be identified and referred before the onset of organ failures, as the risk of death rapidly increases beyond this point. In general, only hospitals with in house ECPR programs can consider ECMO for patients in cardiac arrest. There might be exceptions to this in case of accidental hypothermia and selected toxicology cases where prolonged CPR times are warranted.