2．体外式膜型人工肺（ECMO）

Role of Perioperative Extracorporeal Membrane Oxygenation in Cardiothoracic Surgery

体外式膜型人工肺（extracorporeal membrane oxygenation：ECMO）とは，ポンプと人工肺を用いた体外循環回路により，数日～数週間，一時的に心臓または肺，もしくは心臓・肺の両方を補助する生命維持装置である．これまでに，ECMOは全世界で100,000例近い症例（うち成人は30,000例以上）での使用経験の蓄積があり1），特に重症呼吸不全に対するECMOの有効性が2009年に多施設ランダム化比較試験で示されて以降2），使用数は急激に増加してきている．集中治療領域のみならず，ECMOは心臓および肺を扱う胸部外科領域でもきわめて有用であり，さまざまなシーンでの利用が想定される．

Extracorporeal membrane oxygenation （ECMO） is a temporary mode of providing life support by totally/partially augmenting heart and lung function over a few days to weeks. More than 30,000 cases involving ECMO usage in adults have been reported worldwide since the introduction of this unique therapy, and its applications continue to evolve rapidly. In recent times, ECMO plays a key role not only in the domain of critical care in intensive care units, but is also useful in the field of cardiothoracic surgery；it provides cardiopulmonary support intra- and post-operatively, respiratory support for primary graft dysfunction after lung transplantation and serves as a bridge to lung transplantation. The purpose of this review is to analyze the indications, modes of application, and complications of ECMO use in the field of cardiothoracic surgery.