Extracorporeal life support (ECLS)
ECLS is a collective term for extracorporeal therapies which includes ECMO for the support of cardiac and/or pulmonary failure through the use of an extracorporeal circuit. An overview is provided in figure1 below. The term does not include short-term extracorporeal support modalities for ventricular support without an oxygenator (temporary LVAD, temporary RVAD or temporary BiVAD).
Extracorporeal carbon dioxide removal (ECCO2R)
ECCO2R is the provision of carbon dioxide exchange through the use of an extracorporeal circuit consisting of a membrane oxygenator and optionally of a blood pump. The term partial extracorporeal life support is also used since lower blood flows are required. These systems are not specifically covered in this protocol and are not currently in use at The Alfred. This includes the arterio-venous partial support system (Novalung) which is not available in Australia.
Extra Corporeal Membrane Oxygenation (ECMO) is a form of extracorporeal life support involving an external artificial circuit that carries venous blood from the patient to a gas exchange device (oxygenator) where blood is oxygenated and carbon dioxide removed. This blood then re-enters the patient’s circulation. ECMO circuit blood flow is sufficient to provide adequate patient support in the absence of native lung or heart function.
Prolonged ECLS is a continuous episode of extracorporeal support with duration of more than 28 days. It does not indicate the type or mode of ECLS.
Extracorporeal cardiopulmonary resuscitation (ECPR)
ECPR is the application of rapid-deployment venoarterial ECMO, usually by peripheral cannulation, to provide circulatory support in patients in whom conventional cardiopulmonary resuscitation (CPR) is unsuccessful in achieving sustained return of spontaneous circulation (ROSC). Sustained ROSC is deemed to have occurred when chest compressions are not required for 20 minutes consecutively and signs of circulation persist.
Extracorporeal interval support for organ retrieval (EISOR)
The use of venoarterial ECMO to provide organ perfusion in non-heart-beating organ donors during the interval between declaration of death and organ retrieval. This is currently not practiced at our institution.
Short Term Mechanical Ventricular Support Modes
Extracorporeal circuits including blood pumps for left ventricular support (LVAD), right ventricular support (RVAD) or biventricular support (BiVAD) but without membrane oxygenation are not included in the definition of ECLS and are not ECMO.