Crit Care Resusc
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Extracorporeal life support (ECLS) is a lifesaving technology that is being increasingly used in patients with severe cardiorespiratory failure. However, ECLS is not without risks. The biosynthetic interface between the patient and the circuit can significantly alter inflammation, coagulation, pharmacokinetics and disposition of trace elements. The relative contributions of the pump, disease and patient in propagating these alterations are difficult to quantify in critically ill patients with multiple organ failure. ⋯ The establishment of in-vitro and in-vivo models provides a powerful means for enhancing knowledge of the pathophysiology associated with ECLS and identification of key factors likely to influence patient outcomes. A clearer description of the contribution of disease and therapeutic interventions may allow improved design of equipment, membranes, medicines and physiological goals for improved patient care.