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Ann Thorac Surg 2006;81:1406-1407
© 2006 The Society of Thoracic Surgeons
Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710
(Email: h.grocott{at}duke.edu).
Extracorporeal membrane oxygenation (ECMO) is increasingly used as a means to support patients suffering from severe but reversible pulmonary or cardiac failure, or both. As the frontiers of both cardiothoracic surgery and critical care medicine are continually advanced, it is expected that the numbers of patients that will receive and hopefully benefit from ECMO will increase substantially in the coming years. Although this life-support mechanism is offered to patients who would otherwise succumb to their illness, one cannot help being concerned that this aggressive resuscitative technique may lead to more harm than good, potentially replacing mortality with significant morbidity.
Several messages can be taken from this article by Risnes and colleagues [1]. First, as the vast majority of information on the outcome after ECMO is from the neonatal and pediatric literature, what Risnes and colleagues [1] provide is valuable information on the long-term neurologic sequelae after ECMO in adult populations. Second, yet not the main focus of this article, is the overall reasonably good survival of these patients. The very fact that 5-year survival follow-up is possible and being reported here is a testament to this impressive surgical option. Keeping in mind that these patients are the sickest of the sick, to have this survival rate is a tribute to the development and advancements in ECMO technology that have been propagated during the past decades. Last, this report elaborates that although there can be significant and serious cerebral complications of ECMO, for the most part, the majority of these patients have a fairly reasonable quality of life with most of them returning to the workplace, and none of them having so significant a neurologic abnormality that they were not able to ambulate.
There are obviously considerable limitations to this type of retrospective observational study, not the least of which is the fact that some of the pre-morbid conditions of these patients that necessitated their requirement for ECMO may have contributed to the subsequent longer-term findings. However, as there are few meaningful reports of the long-term sequelae of ECMO in adults elsewhere in the literature, I believe that this article adds considerable knowledge to the field.
How can this report add value to our daily practice and to this field of research in general? With this useful information revealed by Risnes and colleagues [1], patients and family members can now be given, perhaps now with added confidence, meaningful information about what to expect in the long term. In addition, identification of a problem (ie, cerebral injury) is the first step toward identifying the mechanisms of these complications that will hopefully lead to the development of techniques and therapies to prevent and treat these problems in the future.
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