In this article, summary data from the annual international Extracorporeal Life Support Organization (ELSO) Registry Reports through July 2012 are presented. Nearly 51,000 patients have received extracorporeal life support (ECLS). Of the patients, 50% (>25,000) were neonatal respiratory failure, with a 75% overall survival to discharge or transfer. Congenital diaphragmatic hernia remains a major use of ECLS in this population with 51% survival. Extracorporeal life support use for pediatric respiratory failure has nearly doubled since 2000, with approximately 350 patients treated per year in the past 3 years examined (56% survival). Previously stable at about 100 cases a year for a decade, adult respiratory failure ECLS cases increased dramatically in 2009 with the H1N1 influenza pandemic and publication of the Conventional ventilation or ECMO for Severe Adult Respiratory failure (CESAR) trial results and have remained at approximately 400 cases a year through 2011 (55% survival). Use of ECLS for cardiac support represents a large area of consistent growth. Approximately 13,000 patients have been treated with survival to discharge rates of 40%, 49%, and 39% for neonates, pediatric, and adults, respectively.

The use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (ARF) in adults is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMO is a complex, high-risk, and costly modality, at present it should be conducted in centers with sufficient experience, volume, and expertise to ensure it is used safely. This position paper represents the consensus opinion of an international group of physicians and associated health-care workers who have expertise in therapeutic modalities used in the treatment of patients with severe ARF, with a focus on ECMO. The aim of this paper is to provide physicians, ECMO center directors and coordinators, hospital directors, health-care organizations, and regional, national, and international policy makers a description of the optimal approach to organizing ECMO programs for ARF in adult patients. Importantly, this will help ensure that ECMO is delivered safely and proficiently, such that future observational and randomized clinical trials assessing this technique may be performed by experienced centers under homogeneous and optimal conditions. Given the need for further evidence, we encourage restraint in the widespread use of ECMO until we have a better appreciation for both the potential clinical applications and the optimal techniques for performing ECMO.

First described in the suprachiasmatic nucleus, circadian clocks have since been found in several peripheral tissues. Although obesity has been associated with dysregulated circadian expression profiles of leptin, adiponectin, and other fat-derived cytokines, there have been no comprehensive analyses of the circadian clock machinery in adipose depots. In this study, we show robust and coordinated expression of circadian oscillator genes (Npas2, Bmal1, Per1-3, and Cry1-2) and clock-controlled downstream genes (Rev-erbα, Rev-erbβ, Dbp, E4bp4, Stra13, and Id2) in murine brown, inguinal, and epididymal (BAT, iWAT, and eWAT) adipose tissues. These results correlated with respective gene expression in liver and the serum markers of circadian function. Through Affymetrix microarray analysis, we identified 650 genes that shared circadian expression profiles in BAT, iWAT, and liver. Furthermore, we have demonstrated that temporally restricted feeding causes a coordinated phase-shift in circadian expression of the major oscillator genes and their downstream targets in adipose tissues. The presence of circadian oscillator genes in fat has significant metabolic implications, and their characterization may have potential therapeutic relevance with respect to the pathogenesis and treatment of diseases such as obesity, type 2 diabetes, and the metabolic syndrome.

To determine current rates, risk factors, and causal organisms related to infections acquired during extracorporeal membrane oxygenation (ECMO). A descriptive and retrospective case-control study. ECMO centers belonging to the Extracorporeal Life Support Organization. The Extracorporeal Life Support Organization Registry was queried for data related to all ECMO cases from 1998 through 2008. All culture-proven infections obtained from any site during ECMO support and not believed preexisting were included. Infection rates were analyzed by age category (i.e., neonatal, pediatric, adult), indication for ECMO (i.e., respiratory, cardiac, cardiopulmonary resuscitation), mode of ECMO (e.g., venovenous), and duration of ECMO support. Infected and noninfected ECMO patients were compared. None. A total of 2,418 infections were reported during 20,741 (11.7%) ECMO cases for a rate of 15.4 per 1,000 ECMO days. Rates were highest in the adult vs. the pediatric and neonatal populations (30.6 vs. 20.8 vs. 10.1 infections per 1,000 ECMO days, respectively) and in those necessitating extracorporeal cardiopulmonary resuscitation (24.7 infections per 1,000 ECMO days). In each age category, venoarterial ECMO was the mode of support associated with the highest rate of infection. Prevalence of infection increased with duration of ECMO support from 6.1% of those requiring bypass for ≤ 7 days to 30.3% of those requiring ECMO for >14 days (p < .001). Coagulase-negative staphylococci (15.9%) were the most common organisms cultured followed by species of Candida (12.7%), and Pseudomonas (10.5%). Those with an infection acquired during ECMO support were significantly older, had a longer duration of ECMO, a longer duration of post-ECMO ventilatory support, and a higher prevalence of death than those without. Infections acquired during ECMO are common and can have significant associated consequences. Knowledge of high-risk patients and common causal organisms may improve strategies for treatment and prevention, but further work to develop strategies and guidelines for prevention of these infections is urgently needed.

In this article, data from the annual international Extracorporeal Life Support Organization (ELSO) Registry Reports through July 2004 are presented. Nearly 29,000 patients have received extracorporeal life support (ECLS). Of the patients, 66% (more than 19,000) were neonatal respiratory failure, with a 77% overall survival to discharge or transfer. The number of neonatal respiratory cases reported to the Registry has decreased from a peak of 1,500 patients in 1992 and has leveled off at approximately 800 cases per year. The number of pediatric respiratory cases has remained at approximately 200 cases per year since 1993, with a 56% survival to discharge or transfer. Adult respiratory failure continues to be the smallest age group treated with extracorporeal membrane oxygenation (ECMO), with less than 100 cases per year. Survival to discharge, however, is comparable with pediatric respiratory failure (53%). Support continues to increase for cardiac failure across all age groups, with survival to discharge rates of 38%, 43%, and 33% for neonatal, pediatric, and adults, respectively. Survival in pediatric and adult respiratory failure cases supported with ECLS has remained fairly consistent over the past 5 years.

Extracorporeal life support (ECLS) was developed more than 50 years ago, initially with venoarterial and subsequently with venovenous configurations. As the technique of ECLS significantly improved and newer skills developed, complexity in terminology and advances in cannula design led to some misunderstanding of and inconsistency in definitions, both in clinical practice and in scientific research. This document is a consensus of multispecialty international representatives of the Extracorporeal Life Support Organization, including the North America, Latin America, EuroELSO, South West Asia and Africa, and Asia-Pacific chapters, imparting a global perspective on ECLS. The goal is to provide a consistent and unambiguous nomenclature for ECLS and to overcome the inconsistent use of abbreviations for ECLS cannulation. Secondary benefits are ease of multicenter collaboration in research, improved registry data quality, and clear communication among practitioners and researchers in the field.