Extracorporeal Membrane Oxygenation: Beyond Cardiac Surgery and Intensive Care Unit: Unconventional Uses and Future Perspectives

Extracorporeal membrane oxygenation (ECMO) is used with increasing frequency to treat severe cardiac or respiratory failure as it can provide respiratory only or combined circulatory and respiratory support. Despite efforts aimed at increasing its diffusion however, ECMO is currently reserved, usually as last resort, in very severe cases, which are managed almost exclusively in the intensive care unit (ICU). Recent improvements in both technology and patients' management is leading to constant improvement in patients' outcome, especially in centers with a high caseload volume and after ensuring careful patients' selection. Moreover, since short ECMO runs are associated with limited complications, there are now several potential situations outside the ICU and outside the cardiac surgery setting where ECMO is being (or could be) successfully employed to provide cardio-respiratory support, including: high-risk structural heart interventions, ventricular tachycardia ablation, cesarean section, trauma, and, most interestingly, non-cardiac elective procedures in patients at high risk for perioperative cardiac or respiratory complications. Given the increased availability and the good outcomes of ECMO, when carefully employed, we are thus moving towards a future in which no patient should be denied diagnostic or therapeutic procedure exclusively due to high cardiorespiratory risk.