Management of Adult Patients Supported with Venovenous Extracorporeal Membrane Oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO)

The use of venovenous extracorporeal membrane oxygenation (VV ECMO) among adults is rapidly increasing worldwide. By 2020, the Extracorporeal Life Support Organization (ELSO) Registry had recorded >24,000 cases of adult respiratory ECMO use among 282 centers internationally. Venovenous extracorporeal membrane oxygenation is a therapy in the management of respiratory failure in multiple guidelines. Extracorporeal Life Support Organization provides guidelines to inform and guide the initiation, use, management, and weaning of VV ECMO for adult patients with respiratory failure.

In this statement, we provide recommendations for the clinical management of adult patients supported with VV ECMO. Although these recommendations were not developed using a formal, reproducible methodology, we have reviewed English-language publications in PubMed, where available, in developing the guidance provided herein. As this is the fifth revision of these adult respiratory VV ECMO guidelines, we expect that it will be revised at regular intervals as new information, devices, treatments, and techniques become available. As with all guidelines, this statement should not replace the medical judgment and the multidisciplinary decision to establish and manage a patient’s ECMO support strategy. A number of important management principles and recommendations are made in other ELSO guidelines, including: circuit components, patient selection, patient and circuit management, patient sedation, and nutrition. This document contains numerous additional literature references, organized by topic, found in Supplemental Digital Content 1, http://links.lww.com/ASAIO/A626.