{'fraction_non_alphanumeric': 0.023824650571791613, 'fraction_numerical': 0.032083862770012704, 'mean_word_length': 5.235643564356436, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Extracorporeal Organ Support: From Technological Tool to Clinical Strategy Supporting Severe Organ Failure.

Mechanical ventilation, renal replacement therapy, and artificial liver detoxification circuits are among the systems designed to support or replace organs compromised by trauma, sepsis, or acute respiratory, kidney, or liver failure. Among these systems, extracorporeal membrane oxygenation (ECMO) has recently generated increasing expectations despite results from early clinical trials in adults that suggested ECMO use should be restricted to only those patients determined by specialized clinicians to have a very high risk of mortality. Although ECMO remains an uncommon procedure, Karagiannidis et al1 reported that the use of ECMO in Germany increased from 1 per 100 000 individuals per year in 2007 to 2.4 per 100 000 per year in 2014. Rush et al2 reported that the use of ECMO in the United States increased from 1 per 100 000 individuals per year in 2006 to 6.1 per 100 000 per year in 2011. This increased use of ECMO is partially due to improvements in the design of pumps, oxygenators, biocompatible tubing, and catheters, which together have created the widely held perception that ECMO is safer and easier to use.3 ECMO was developed in the 1960s to replace heart and lung function until heart surgery could be performed. It was subsequently used in a venoarterial configuration to provide circulatory support for severe heart failure and in a venovenous configuration to provide gas exchange support for severe lung failure. Venoarterial ECMO has shown promising results for supporting hemodynamic status in patients with cardiogenic shock and cardiac arrest. For those in whom spontaneous circulation is not restored, ECMO has been proposed to preserve peripheral organs for donation after cardiac death.4 Acute respiratory distress syndrome (ARDS) is the most common indication for venovenous ECMO. In a study reported in 2009, compared with those who were not transferred to an ECMO center (n = 90), patients with severe ARDS transferred to an ECMO center (n = 90) had a significantly higher 6-month survival rate without disability (47% vs 63%, respectively).5 According to a study conducted during the 2009 influenza A(H1N1) pandemic, 25% of 272 hospitalized patients developed severe ARDS.6 A subsequent study showed that of the 201 patients with ARDS due to influenza A(H1N1), 68 patients (34%) received ECMO, and their survival rate was approximately 70%.7 However, another study showed comparable outcomes in patients with ARDS due to influenza A(H1N1) who were managed with ECMO or without ECMO.8 A multidisciplinary group of 24 experts (intensive care medicine, anesthesia, cardiology, cardiac surgery, pediatrics, nephrology, and pulmonology) held a roundtable meeting on ECMO in March 2017. This Viewpoint summarizes the main challenges identified, particularly those related to the terminology and clinical organizational models that will help ECMO evolve from a device for use only as a last resort to a technique that is used as part of an advanced strategy for treating patients with severe organ failure.