History of ECMO
Extracorporeal membrane oxygenation is the use of extracorporeal circulation and gas exchange to provide temporary life support to patients with cardiac or pulmonary failure. One key component of ECMO is the transport of oxygen into blood across a semi-permeable membrane. This phenomenon was first recognized in 1944 when Kolff and Berk noted that blood became oxygenated as it passed through the cellophane chambers of their artificial kidney.
The concept of cardiopulmonary bypass was developed in the early 1950's. Devices used at that time were bubble or disk oxygenators with a direct oxygen-blood interface. Hemolysis occurred after a few hours of bypass. This precluded its use for long-term support. The development of the first membrane oxygenator, by Clowes in 1956, enabled prolonged cardiopulmonary bypass to become feasible.
The 1960's and 1970's were noted for advances in techniques and research, for prolonged pulmonary support. A nine hospital collaborative study was organized by the National Heart, Lung, and Blood Institute to study ECMO therapy, in adults with pulmonary insufficiency. Unfortunately, survival was not improved. The study had several problems: (1) the patients varied greatly as to the type and complexity of their disease process; (2) patients were often entered when lung damage was predicted as irreversible; (3) intensive ventilatory support was continued, which perpetuated lung damage.
The early ECMO experience in children was similar to that in the adult. However, these studies suggested that in appropriate patients who were treated early and did not have irreversible lung damage, ECMO was technically feasible with the potential to reverse pulmonary failure.
The first newborn population chosen for ECMO was the premature infant with hyaline membrane disease. These infants suffered an unacceptably high risk of intracranial hemorrhage. The combination of Hypoxia, hypothermia, acidosis, systemic heparinization, and alterations of cerebral circulation resulted in a prohibitively high mortality. A milestone in the history of ECMO was reached when Bartlett and associates pioneered the treatment of term or near term infants in acute, reversible respiratory failure.
Because of the pioneering efforts of Dr.Bartlett and his associates, we are able to offer ECMO to this population successfully. There are currently over eighty-five centers, internationally, offering ECMO with over 20,000 infants treated to date. The average survival rate is 83% for newborns, whom previously had a predicted survival of 20% without ECMO.
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