A brief history of ECMO

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Chapter 1 A brief history of ECMO




Starting point


Extracorporeal membrane oxygenation (ECMO) support is a form of extracorporeal life support. ECMO is not a treatment and does not correct the underlying pathological insult. The technology is a direct extension from cardiopulmonary bypass and the heart–lung machine used in cardiac surgery.


Extracorporeal life support technologies include other devices, such as dialysis, continuous haemofiltration and ventricular assist devices


Table 1.1 lists the main events that contributed to the development of ECMO. Early attempts at mixing gas and blood were hindered by thrombus (blood clot) formation. The discovery of heparin at the start of the 20th century circumvented this obstacle. Various devices to allow mixing of gas and blood were developed, with the bubble oxygenator probably the most recognized. In this system, the gas literally bubbled up in the blood. Great attention to the size of the bubbles and the circuit design with traps allowed this to happen without the air bubbles being entrained into the patient’s bloodstream and causing an air embolism. The mixing of gas and blood caused multiple disruptions to the blood homeostasis and limited the duration of exchange. Interposing a semi-permeable membrane between the air and the blood was a key development that allowed longer periods of support.



Table 1.1 Milestones in the history of ECMO support














































































Year Event
1635–1703 Robert Hooke conceptualizes the notion of an oxygenator.
1869 Ludwig and Schmidt attempt to oxygenate blood by shaking together defibrinated blood with air in a balloon.
1882 von Schröder of Strasburg uses a bubble oxygenator to oxygenate an isolated kidney.
1882 Frey and Gruber describe the first ‘two-dimensional’, direct-contact extracorporeal oxygenator, which exposed a thin film of blood to air in an inclined cylinder, which was rotated by an electric motor.
1916 Discovery of heparin when Jay Maclean demonstrates that a phosphatide extracted from canine heart muscle prevents coagulation of the blood.
1929 First whole-body extracorporeal perfusion of a dog by Brukhonenko and Tchetchuline.
1930s Gibbon and Kirkland further develop the concept of the oxygenator.
1948 Bjork describes the rotating disc oxygenator.
1952 All-glass bubble oxygenator by Clarke, Gollan and Gupta.
1953 First successful human intracardiac operation under direct vision using a mechanical extracorporeal pump oxygenator.
1955 Kirklin and colleagues at the Mayo Clinic further developed the Gibbon-type stationary screen oxygenator into the Mayo–Gibbon pump oxygenator apparatus, and made it available for commercial use.
1955 Lillehei and colleagues then begin to use the DeWall bubble oxygenator clinically.
1958 Clowes, Hopkins and Neville use 25 m2 of permeable ethylcellulose (soon replaced by the mechanically stronger polytetrafluoroethylene or Teflon) in multiple sandwiched layers to form the first clinical membrane oxygenator.
1972 Hill reports the first adult survivor on ECMO.
1972 Editorial in the New England Journal of Medicine by Zapol: ‘Buying time with artificial lungs’.
1976 Bartlett reports the successful use of ECMO on an abandoned newborn nicknamed Esperanza by the nursing staff.
1978 Kolobow and Gattinoni describe using extracorporeal circulation to remove carbon dioxide, allowing a potential decrease in ventilation harm.
1979 Publication of a randomized controlled trial in adult patients with acute respiratory distress syndrome (ARDS) by the National Heart, Lung and Blood Institute: disappointing results with 10% survival in either group.
1989 Founding of the Extracorporeal Life Support Organization (ELSO).
2009 H1N1 influenza pandemic and data relating to clinical success with ECMO are widely disseminated, including in the lay press.
2009 ‘Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomized controlled trial’, published in The Lancet.
2011 The National Health Service (England) commission a national respiratory ECMO service.
2014 Publication of ‘Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients’ in the American Journal of Respiratory and Critical Care Medicine.

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May 8, 2017 | Posted by in RESPIRATORY | Comments Off on A brief history of ECMO

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