{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:43:21Z","timestamp":1791668601435,"version":"4.3.4"},"reference-count":45,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T00:00:00Z","timestamp":1737417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Extracorporeal membrane oxygenation (ECMO), an advanced life support method, was developed to treat severe cardiac and pulmonary failure in critically ill patients. ECMO was previously used to treat ARDS, cardiogenic shock, and after heart or lung transplant. It has since become a versatile therapeutic and surgical tool. When conventional methods fail, this technique works well for high-risk procedures such as tracheal resections, ventricular tachycardia ablations, and complicated percutaneous coronary interventions. These uses demonstrate ECMO\u2019s ability to oxygenate and stabilize the hemodynamics in challenging clinical circumstances. Clinical studies report survival rates exceeding 60% in ECMO-assisted thoracic surgeries, underscoring its efficacy in these settings. Recent advancements, such as portable ECMO systems and artificial intelligence-driven management tools, have further enhanced the safety and effectiveness of ECMO, enabling its use in diverse clinical environments. However, challenges remain, particularly in patient selection, resource allocation, and addressing ethical dilemmas. The integration of standardized protocols and technological innovations has mitigated complications such as vascular injury and infection, contributing to improved patient outcomes. This review examines ECMO applications and integration into multidisciplinary care, its configurations, and its growing role outside the intensive care unit in elective thoracic and cardiac surgery, trauma, and non-cardiac high-risk procedures.<\/jats:p>","DOI":"10.3390\/medicina61020174","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T06:53:32Z","timestamp":1737442412000},"page":"174","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Rising Above the Limits of Critical Care ECMO: A Narrative Review"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3878-044X","authenticated-orcid":false,"given":"Pietro","family":"Bertini","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine, Casa di Cura Privata San Rossore, 56122 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8100-3304","authenticated-orcid":false,"given":"Alberto","family":"Marabotti","sequence":"additional","affiliation":[{"name":"Intensive Care Unit and Regional, ECMO Referral Centre, Azienda Ospedaliero, Universitaria Careggi, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Meani","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0645-2000","authenticated-orcid":false,"given":"Fabio","family":"Sangalli","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, ASST Valtellina e Alto Lario, University of Milano-Bicocca, 23020 Sondrio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4032-0821","authenticated-orcid":false,"given":"Gianluca","family":"Paternoster","sequence":"additional","affiliation":[{"name":"Department of Health Science, Anesthesia and ICU, School of Medicine, University of Basilicata San Carlo Hospital, 85100 Potenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1542\/peds.76.4.479","article-title":"Extracorporeal circulation in neonatal respiratory failure: A prospective randomized study","volume":"76","author":"Bartlett","year":"1985","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1164\/rccm.201404-0630CP","article-title":"Position Paper for the Organization of Extracorporeal Membrane Oxygenation Programs for Acute Respiratory Failure in Adult Patients","volume":"190","author":"Combes","year":"2014","journal-title":"Am. 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