<unk>  sketch<unk>  circuit Guidelines that describe the indications and practice of<unk>  are published by the<unk>  Life Support Organization (ELSO). Criteria for the initiation of<unk>  vary by institution, but generally include acute severe cardiac or pulmonary failure that is potentially reversible and unresponsive to conventional management. Examples of clinical situations that may prompt the initiation of<unk>  include the following: * Hypoxemic respiratory failure with a ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2) of <100 mmHg despite optimization of the ventilator settings, including the fraction of inspired oxygen (FiO2), positive end-expiratory pressure (PEEP), and inspiratory to expiratory (I:E) ratio * Hypercapnic respiratory failure with an arterial pH <7.20 * Refractory cardiogenic shock * Cardiac arrest * Failure to wean from cardiopulmonary bypass after cardiac surgery * As a bridge to either heart transplantation or placement of a ventricular assist device * As a bridge to lung transplantation * Septic shock is a more controversial but increasingly studied use of<unk>  * Hypothermia, with a core temperature between 28 and 24 °C and cardiac instability, or with a core temperature below 24 °C. In those with cardiac arrest or cardiogenic shock, it appears to improve survival and good outcomes. Use in COVID-19 patients Beginning in early February 2020, doctors in China have increasingly been using<unk>  as an adjunct support for patients presenting with acute viral pneumonia associated with SARS-CoV-2 infection (COVID-19) when, with ventilation alone, the blood<unk>  levels still remain too low to sustain the patient. The initial reports indicate that it is assisting in restoring patients' blood oxygen saturation and reducing fatalities among the approximately 3% of severe cases where it has been utilized. For critically ill patients, the mortality rate reduces from around 59–71% with conventional therapy to approximately 46% with<unk> . A March 2021 Los Angeles Times cover story illustrated the efficacy of<unk>  in an extremely challenging COVID patient. In February 2021, three pregnant Israeli women who had "very serious" cases of COVID-19 were given<unk>  treatment and it seemed this treatment option would continue. Outcomes Early studies had shown survival benefit with use of<unk>  for people in acute respiratory failure especially in the setting of acute respiratory distress syndrome. A registry maintained by ELSO of nearly 51,000 people that have received<unk>  has reported outcomes with 75% survival for neonatal respiratory failure, 56% survival for pediatric respiratory failure, and 55% survival for adult respiratory failure. Other observational and uncontrolled clinical trials have reported survival rates from 50 to 70%. These reported survival rates are better than historical survival rates. Even though<unk>  is used for a range of conditions with varying mortality rates, early detection is key to prevent the progression of deterioration and increase survival outcomes. In the United Kingdom, veno-venous<unk>  deployment is concentrated in designated<unk>  centers to potentially improve care and promote better outcomes.
Extracorporeal membrane oxygenation
Surfactant therapy
Cardiopulmonary bypass
Transtracheal jet ventilation
Artificial ventilation
Mechanical ventilation
Heart–lung transplant
Bubble oxygenator