2．ECMO

Extracorporeal Membrane Oxygenation （ECMO） as an Emerging Technology：Present and Future

体外式膜型人工肺（ECMO）は，重症呼吸不全や循環不全に対する救命的治療として普及している．その一方で高度な専門知識と多職種の連携が求められ，運用の複雑さとコストの高さが導入拡大の障壁となってきた．こうした中で，近年の技術革新はECMOの敷居を下げ，より安全かつ柔軟な運用を可能とする方向へとすすんでいる．本稿では，最新のECMO関連技術の進展を，主に小型・可搬型装置，ポンプ・人工肺の改良，自動制御，安全性向上の観点から概説する．

Extracorporeal membrane oxygenation （ECMO） has become an essential therapeutic modality for severe respiratory and circulatory failure. Recent technological advances have lowered the operational threshold for ECMO by enabling safer, more portable, and user-friendly systems. This article reviews the latest developments in ECMO-related technologies from the perspective of practicing clinicians. Key topics include the miniaturization and transportability of devices, improvements in centrifugal pumps and membrane lungs, and the incorporation of real-time monitoring and automatic control. Surface coatings using phosphorylcholine or hydrophilic polymers have enhanced biocompatibility and extended device longevity. Artificial intelligence and deep learning are being explored to assist in real-time decision-making and survival prediction. Furthermore, the potential for long-term implantable oxygenators is gaining attention. Our group has demonstrated prolonged in vivo function of a novel silicone membrane lung with methacryloyloxyethyl phosphorylcholine （MPC） polymer coating in large animal models, achieving thrombosis-free support for up to 100 days. The early conceptual framework for an implantable intrathoracic artificial lung, proposed by Mortensen in 1994, is gradually becoming technically feasible thanks to material and design innovations. These multifaceted advancements promise to broaden the future clinical applications of ECMO and improve outcomes across both acute and chronic indications.