Device Overview

Figure 1: Basic diagram showing how ECMO works

ECMO stands for Extracorporeal Membrane Oxygenation. It is a form of therapy that takes over the function of the heart and lungs when the patient’s own are no longer able to function, aiding the diffusion of oxygen into and carbon dioxide out of the patient’s blood supply. It is an therapy administered in extreme cases and should only be used as a last resort, when all other conventional treatments are unable to resolve the heart and lung problems. In such cases, it serves to keep the function of the heart and lungs going while doctors treat the underlying condition. Examples of illnesses that ECMO treats include pneumonia, pulmonary embolism, myocarditis and COVID-19.

History of ECMO

Figure 2: Timeline of ECMO developments

Developed in the late 1960s, the ECMO system was first implemented in 1971 on a patient suffering from lung dysfunction and worsening acute respiratory distress syndrome (ARDS) post a motorcycle accident. The ECMO was administered using a Bramson membrane heart-lung machine (uses a membrane lung to support the patient's circulatory system), continuously for 75 hours. In the wake of the H1N1 influenza pandemic in 2009, this system was used globally manage severe lung failure. More recently, the COVID-19 pandemic led to a large rise in respiratory failure cases, making ECMO an increasingly important treatment. However, its long-term effectiveness remains to be seen still, especially due to less than stellar survival probabilities (a little over 50 percent). This heralds rigorous research and discovery in the field to push the boundaries of the current system and provide wider applicability and long-term sustainability.

Over time, technological developments have made ECMO systems smaller and lighter. Their reduced size have yielded many benefits, including faster implementation, improved patient transport and more convenient emergency use.

Companies Manufacturing ECMO

Figure 3: Nautilus ECMO oxygenator

Figure 4: Graph showing oxygen transfer using the Nautilus oxygenator

Medtronic

Headquartered in Ireland, MedTronic offers a heart-lung bypass with the ECMO system, specifically designed for adult patients with severe respiratory failure. The Nautilus ECMO oxygenator (shown on left) has various features, including a transverse flow-path with a circular profile. Transverse flow minimises surface contact area while achieving a low blood-side pressure drop. Circular profile eliminates corners where clotting commonly occurs. Moreover, the guided inlet reduces velocity changes where low flow and stasis occurs. Lastly, filling vanes aid in even filling and flow distribution across the membrane. These features all support the fact that the Nautilus oxygenator is designed for durability and long-term performance.

Eurosets

Headquartered in Italy, Eurosets is mainly known for the Quadrox oxygenator, a key component of ECMO systems contributing to improved gas exchange efficiency.

Mapping ECMO Manufacture by Geography

(focus on Asia-Pacific region)

Japan: boasts well-developed ECMO infrastructure and strong research abilities
China: overall economic growth has also contributed to rapid growth in the medical device industry, coupled with increased healthcare investment and government initiatives to improve medical device manufacturing, it takes a valuable place as a dominant member in the market
South Korea: advanced medical technology and focus on ECMO-based treatments in tertiary care hospitals allows the country to cement its position as a leading player in the ECMO industry
Singapore: National Heart Centre Singapore (NHCS) performs about 70 ECMO procedures a year and is the largest ECMO centre in Singapore

Figure 5: ECMO availability worldwide

Widely available in many countries in Europe and North America likely due to a larger number of healthcare equipment and personnel (144 ECMO centers in North America)
Less common in places like Africa and Australia (only 2 ECMO centers in Africa)
Moderate availability in Asia (7 ECMO centers in Hong Kong, 9 in Singapore)

Accessing ECMO

ECMO might be recommended by doctors if:

The patient's lungs are unable to get enough oxygen to the body even with extra oxygen
The patient's lungs cannot get rid of enough carbon dioxide even with a mechanical ventilator
The patient's heart cannot pump enough blood around the body

References

[1] Northwestern Medicine (2024) History of ECMO https://www.nm.org/conditions-and-care-areas/pulmonary/extracorporeal-membrane-oxygenation-program/history-of-ecmo#:~:text=ECMO%20technology%20was%20developed%20in,time%20with%20conventional%20bypass%20machines.

[2]Brogan, G. (2021, August 4) The History of ECMO. https://intensiveblog.com/the-history-of-ecmo/#:~:text=1970s%3A%20The%20Birth%20of%20ECMO&text=The%201970s%20saw%20the%20first,ECMO%20as%20we%20know%20it.

[3] Healthcare Industry Insights (2024, February 13) Top 10 Companies in the Extracorporeal membrane oxygenation Industry in 2024 https://www.linkedin.com/pulse/top-10-companies-extracorporeal-membrane-07h1f/

[4] Medtronic (2020, June) Extracorporeal Life Support Products https://europe.medtronic.com/xd-en/healthcare-professionals/products/cardiovascular/extracorporeal-life-support.html#:~:text=Nautilus%E2%84%A2*%20ECMO%20Oxygenator%2C%20Nautilus,and%20exclusively%20distributed%20by%20Medtronic.

[5] Ken Research (2024, October) APAC ECMO Market Outlook to 2028 https://www.kenresearch.com/industry-reports/apac-ecmo-market

[6] ELSO (2024) ECMO Availability Map https://www.elso.org/membership/ecmoavailabilitymap.aspx

[7] Pooboni, S.K. ECMO in India, SWAAC ELSO: challenges and solutions. Indian J Thorac Cardiovasc Surg 37 (Suppl 2), 344–350 (2021). https://doi.org/10.1007/s12055-020-01031-x

[8] Cleveland Clinic (2022, December 29) What is ECMO? https://my.clevelandclinic.org/health/treatments/21722-extracorporeal-membrane-oxygenation-ecmo

Norya Wang

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