Research Advances in the Timing of Initiation for Extracorporeal Life Support
LU Junyu
LI Shuanglei
Abstract：Extracorporeal life support(ECLS),particularly extracorporeal membrane oxygenation(ECMO),is a critical intervention for severe cardiopulmonary failure,with its clinical efficacy highly dependent on the precision of initiation tim-ing.This article systematically reviews the influencing factors and recent advancements in determining the optimal timing for ECMO initiation,focusing on patient age,indications,contraindications,underlying comorbidities,and their associations with clinical outcomes.Evidence indicates that advanced age(>70 years),diabetes,chronic kidney disease,and other comorbidities significantly increase the risk of complications.Key indications include refractory respiratory failure(e.g.,PaO2/FiO2<50 mmHg persisting>3 hours)and cardiogenic shock(e.g.,cardiac index<2.2 L/(min·m²)),contingent upon strict exclusion of absolute contraindications such as irreversible neurological injury or advanced malignancies.Current guidelines emphasize integrating hemodynamic,metabolic,and oxygenation parameters for decision-making,yet global heterogeneity in initiation criteria per-sists,contributing to variable survival rates(29.5%-57.3%in adults).Future research should prioritize multicenter randomized controlled trials to validate dynamic risk assessment models and integrate artificial intelligence-driven strategies for personalized ECMO initiation,thereby advancing precision medicine in critical care.
Keywords：extracorporeal membrane oxygenationinitiation timingacute respiratory distress syndromecardiogenic shockcritical care medicineprognostic factors
Publication Date：2025-10-28
Online Publishing Date：2025-11-20(First online date of this platform, not the publication date of the document)
Pages：9( 441-448,456 )