Extracorporeal membrane oxygenation (ECMO): New technology or just a new tool for developing countries?

Abstract

The management of patient’s mechanical ventilation, in acute respiratory failure and/or adult respiratory distress syndrome in developing countries is generally done by anesthesiologist. Even in developed countries, patients with acute respiratory failure and particularly adult respiratory distress syndrome have a very high mortality rate. Extracorporeal membrane oxygenation (ECMO) is an innovation of high technology in the intensive care medicine which emerged two decades ago. In certain centers in several developed countries, ECMO for acute respiratory failure is used as a rescue therapy or as an alternative therapy at a certain predicted mortality rate. In fact, in neonatal respiratory failure in the United States, ECMO is considered as a standard therapy. Unfortunately, the result of ECMO is different at different age groups. The best results is in neonates, i.e. 70-90% survival rate, while for older children and adults the mortality rate is 45-55% for patients with predicted mortality rate around 80% with mechanical ventilation. Would it be possible to start ECMO therapy in developing countries? ECMO has been unquestionably successful in treating a large number of term infants with respiratory failure, but ECMO is very labor intensive. The cost for ECMO is very high, it is about twice as high as standard intensive care treatment. Taking into considerations the cost benefit analysis and cost effective analysis ECMO would be better carried out in developing countries only at certain hospitals with enough bypass or open heart surgery experience (1-2 selected centers), and is best done only in neonatal respiratory failure.