Editorial
ECMO: Past, present and future in critical care
ECMO: pasado, presente y futuro del paciente crítico
L. Martin-Villen
, R. Martin-Bermudez
Corresponding author
Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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García-Gigorro, E. Renes-Carreño, J.L. Pérez-Vela, H. Marín-Mateos, J. Gutiérrez, M.A. Corrés-Peiretti, J.F. Delgado, E. Pérez-de la Sota, J.M. Cortina-Romero, J.C. Montejo-González" "autores" => array:10 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "García-Gigorro" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Renes-Carreño" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Pérez-Vela" ] 3 => array:2 [ "nombre" => "H." "apellidos" => "Marín-Mateos" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Gutiérrez" ] 5 => array:2 [ "nombre" => "M.A." "apellidos" => "Corrés-Peiretti" ] 6 => array:2 [ "nombre" => "J.F." "apellidos" => "Delgado" ] 7 => array:2 [ "nombre" => "E." "apellidos" => "Pérez-de la Sota" ] 8 => array:2 [ "nombre" => "J.M." "apellidos" => "Cortina-Romero" ] 9 => array:2 [ "nombre" => "J.C." "apellidos" => "Montejo-González" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569117300293" "doi" => "10.1016/j.medin.2016.12.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117300293?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357271730190X?idApp=WMIE" "url" => "/21735727/0000004100000009/v1_201711250720/S217357271730190X/v1_201711250720/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "ECMO: Past, present and future in critical care" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "511" "paginaFinal" => "512" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Martin-Villen, R. Martin-Bermudez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Martin-Villen" "email" => array:1 [ 0 => "luis.martin.exts@juntadeandalucia.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Martin-Bermudez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "ECMO: pasado, presente y futuro del paciente crítico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleSmallCaps">Medicina Intensiva</span>, García-Gigorro et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> analyze mortality and its potential related factors in cardiogenic shock patients requiring extracorporeal membrane oxygenation (ECMO) for stabilization or recovery in a third-level hospital with a heart transplant program. Despite the limited strength of the results of the study, the article underscores that the use of cardiopulmonary assist devices, and particularly ECMO, is a reality in the management of patients with severe heart failure, and introduces a substantial change in their evolution and prognosis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Extracorporeal membrane oxygenation in its different variants, i.e., veno-arterial (VA) and veno-venous (VV), is a total or partial cardiopulmonary assist system that was first used for therapeutic purposes more than 40 years ago.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Over the decades the technique has been characterized by both advantages and drawbacks, though with the development of more compact devices and the introduction of biocompatible materials, its use has become widespread throughout the world – particularly in the early XXI century, thanks to the studies of the University of Michigan and subsequently the CESAR study,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and the series derived from the influenza A epidemic.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Since its creation in 1989, almost 80,000 patients have been included in the Extracorporeal Life Support Organization (ELSO) registry, and the current decade is clearly the time when the use of ECMO in adults has grown exponentially.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The importance of ECMO is also reflected in both the growing number of publications on the technique (from 231 in 2005 to 1062 in 2016) and the ongoing lines of research in this field (128 studies in <span class="elsevierStyleItalic">ClinicTrials</span>). However, despite numerous studies with data favorable to the use of ECMO in critical patients with severe respiratory or heart failure, in which conventional management has failed, there is still not enough scientific evidence to establish a clear indication of the technique in these disease scenarios.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Few studies have been made in Spain to date, and the existing publications are limited to several critical patient series<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> and a single national registry<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> with the implantation of 117 ECMO systems between 2007 and 2010, in 15 national centers.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study of García-Gigorro et al. shows the mortality rate among cardiogenic shock patients requiring VA ECMO to be high (close to 40%), and this rate moreover increases significantly depending on the indication and severity of the patient condition (SAPS II score) at the time of implantation of the technique. These data are comparable to those of other series,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and have resulted in prognostic scales of great use in assessing survival among cardiogenic shock patients amenable to management with devices of this kind.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand, ECMO has been associated to frequent complications and high morbidity, despite relatively good survival among those patients in which the device has been successfully withdrawn. These results remind us of the recommendations of the ELSO when dealing with patients with severe respiratory or heart failure who need ECMO to survive. In effect, the mentioned guidelines underscore the need to take into account that successful assist is conditioned to a series of factors, such as the availability of a device suited to the disease condition and management objective, optimum timing of implantation of the device, an adequate implantation technique, and correct post-implantation management – with special emphasis on the prevention and treatment of possible complications, in order to reduce the high morbidity-mortality of these patients as far as possible.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although the present study has few patients, and its single-center design limits the drawing of firm conclusions, it describes a series of critical patients subjected to VA ECMO that are very representative of the real-life situation in our setting, with findings similar to those published in other countries, and which paves the way to continue investigating in this area of Intensive Care Medicine.</p><p id="par0035" class="elsevierStylePara elsevierViewall">If we believe the notion that “the species that survives is not the strongest or the most intelligent, but the one most receptive to change”, then the use of ECMO very probably will represent one of the substantial changes in the management of critical patients over the coming years. Nevertheless, both the complexity of implantation and the great material and human resources required make it essential for such change to be structured and integrated within a multidisciplinary strategy aimed at ensuring quality care for patients with severe cardiorespiratory failure.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martin-Villen L, Martin-Bermudez R. ECMO: pasado, presente y futuro del paciente crítico. Med Intensiva. 2017;41:511–512.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Soporte mecánico con membrana de oxigenación extracorpórea veno-arterial (ECMO-VA): evolución a corto y a largo plazo tras la retirada de la asistencia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. García-Gigorro" 1 => "E. Renes-Carreño" 2 => "J.L. Perez-Vela" 3 => "H. Marín-Mateos" 4 => "J. 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|---|---|---|---|
| 2024 November | 1 | 5 | 6 |
| 2024 October | 89 | 52 | 141 |
| 2024 September | 90 | 31 | 121 |
| 2024 August | 103 | 38 | 141 |
| 2024 July | 86 | 29 | 115 |
| 2024 June | 92 | 53 | 145 |
| 2024 May | 51 | 27 | 78 |
| 2024 April | 87 | 37 | 124 |
| 2024 March | 84 | 26 | 110 |
| 2024 February | 70 | 45 | 115 |
| 2024 January | 94 | 32 | 126 |
| 2023 December | 87 | 29 | 116 |
| 2023 November | 78 | 36 | 114 |
| 2023 October | 72 | 30 | 102 |
| 2023 September | 77 | 40 | 117 |
| 2023 August | 59 | 11 | 70 |
| 2023 July | 74 | 32 | 106 |
| 2023 June | 75 | 15 | 90 |
| 2023 May | 81 | 34 | 115 |
| 2023 April | 44 | 20 | 64 |
| 2023 March | 101 | 42 | 143 |
| 2023 February | 81 | 33 | 114 |
| 2023 January | 73 | 34 | 107 |
| 2022 December | 114 | 59 | 173 |
| 2022 November | 79 | 36 | 115 |
| 2022 October | 95 | 58 | 153 |
| 2022 September | 85 | 38 | 123 |
| 2022 August | 53 | 40 | 93 |
| 2022 July | 53 | 40 | 93 |
| 2022 June | 62 | 30 | 92 |
| 2022 May | 65 | 52 | 117 |
| 2022 April | 66 | 40 | 106 |
| 2022 March | 75 | 65 | 140 |
| 2022 February | 58 | 41 | 99 |
| 2022 January | 79 | 56 | 135 |
| 2021 December | 62 | 61 | 123 |
| 2021 November | 71 | 49 | 120 |
| 2021 October | 99 | 75 | 174 |
| 2021 September | 75 | 51 | 126 |
| 2021 August | 44 | 42 | 86 |
| 2021 July | 41 | 32 | 73 |
| 2021 June | 47 | 35 | 82 |
| 2021 May | 47 | 45 | 92 |
| 2021 April | 218 | 120 | 338 |
| 2021 March | 108 | 24 | 132 |
| 2021 February | 64 | 20 | 84 |
| 2021 January | 79 | 24 | 103 |
| 2020 December | 49 | 24 | 73 |
| 2020 November | 75 | 19 | 94 |
| 2020 October | 50 | 27 | 77 |
| 2020 September | 55 | 32 | 87 |
| 2020 August | 33 | 22 | 55 |
| 2020 July | 43 | 29 | 72 |
| 2020 June | 66 | 36 | 102 |
| 2020 May | 44 | 10 | 54 |
| 2020 April | 37 | 11 | 48 |
| 2020 March | 27 | 20 | 47 |
| 2020 February | 117 | 28 | 145 |
| 2020 January | 58 | 33 | 91 |
| 2019 December | 45 | 25 | 70 |
| 2019 November | 39 | 26 | 65 |
| 2019 October | 53 | 32 | 85 |
| 2019 September | 53 | 37 | 90 |
| 2019 August | 77 | 33 | 110 |
| 2019 July | 55 | 37 | 92 |
| 2019 June | 86 | 35 | 121 |
| 2019 May | 107 | 51 | 158 |
| 2019 April | 99 | 38 | 137 |
| 2019 March | 88 | 32 | 120 |
| 2019 February | 60 | 37 | 97 |
| 2019 January | 50 | 32 | 82 |
| 2018 December | 43 | 61 | 104 |
| 2018 November | 80 | 87 | 167 |
| 2018 October | 58 | 26 | 84 |
| 2018 September | 31 | 16 | 47 |
| 2018 August | 23 | 6 | 29 |
| 2018 July | 37 | 13 | 50 |
| 2018 June | 54 | 13 | 67 |
| 2018 May | 17 | 8 | 25 |
| 2018 April | 39 | 17 | 56 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 1 | 0 | 1 |
| 2018 January | 4 | 3 | 7 |
| 2017 December | 3 | 3 | 6 |
| 2017 November | 0 | 3 | 3 |
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