Newer Indications and challenges

Technological development of extracorporeal systems of the last 30 years led to extremely improved high-flow venoarterial or venovenous extracorporeal systems for cardiovascular support and refractory hypoxia and to less invasive low-flow systems for extracorporeal CO Oxygenation through modern polymethylpentene membrane lungs is nearly optimal: hemoglobin of blood exiting the membrane lungs is almost fully saturated, and oxygen partial pressure is close to the maximal theoretically achievable. On the contrary CO2 removal is less efficient, since only a small fraction of the total blood CO2 is present in the dissolved form, the only fraction which can be readily removed by the membrane lung. Promising technological developments, exploiting the bicarbonate ions, which represent almost 90 % of the total blood CO2 content, lead toward ultra low-flow CO2 removal systems. Moreover, clinical and organizational improvements are foreseeable that might improve indications, management, and outcome for ECMO patients.