Challenges in extracorporeal membrane oxygenation: Precision management to improve survival

The increase in survival rate under ECMO in many centres, the constant demands from governments and public opinion to increase support to reduce mortality in ICU have dramatically increased the number of ECMO centres and its application worldwide. Despite that, the basic scientific evidence of ECMO's superiority over other conventional or experimental treatments does not lie in classical evidence-based medicine and, furthermore, a number of issues in the daily management in several topics are unknown or neglected. The aim of this thesis was to elucidate clinical data and basic knowledge related to various challenges in ECMO practice in order to collect more solid data on current practice and guide future management strategies and interventional investigations. The topics considered in this PhD research were the anticoagulation management and best trigger for transfusions, the updated strategies to reduce the risk of limb ischemia during cardiac support, new biomolecular markers to monitor the clinical evolution of patients and the treatment of complications in a less-invasive way to improve survival All these considerations taken together may contribute to a more precise ECMO management, and a more efficient and sustainable allocation of this high-demanding health care resource, even more during the pandemic time.