Extracorporeal Life Support in Critical Care Medicine

W ITH THE INTRODUCTION of intensive care units in the 1960s an environment was established for aggressive patient care. Current technologic achievements continue to improve the means by which this care is provided. Hemodialysis, ventilators, parenteral nutrition, and ventricular assist devices all offer temporary, or occasionally permanent, support for failing organ systems. Extracorporeal circulation devices, utilizing pumps and external oxygenators, represent one of the most powerful tools available to the intensivist, surgeon, or neonatologist. They can provide pulmonary or combined cardiopulmonary support. The technique of extracorporeal circulation has been available and in use for the past 20 years. It has become an accepted form of therapy in the management of neonates with respiratory failure, secondary to pulmonary hypertension, infection, or toxic aspiration. Its role in the management of pediatric and adult respiratory or cardiac failure is becoming more clearly defined. It is incumbent that the intensivist understand the potential benefits of extracorporeal life support (ECLS), its proper applications and inherent complications, to fully incorporate this therapeutic modality in patient management.