1. Development History of ECMO

ECMO began in the 1960s, derived from the cardiopulmonary bypass technology first applied to open heart surgery in Gibbon in 1953, and successfully used to treat acute respiratory distress syndrome in adults and newborns in 1971 and 1975, respectively. ECMO technology matured in the 1980s, and ECMO centers were established in 1983 at the Medical College of Virginia, the University of Michigan, and the University of Pittsburgh, but the success rate of early ECMO support was not high. In order to promote the exchange and application of ECMO technology worldwide, the International Extracorporeal Life Support Organization (ELSO) was established at the University of Michigan in 1989 under the promotion of Professor Bartlett. However, until 2004, only more than 100 hospitals in the world carried out this work, and mainly concentrated in Western developed countries. Since 2008, when ECMO was successfully used to treat patients with influenza A, the number of ECMO worldwide has begun to show a rapid growth trend.

With the gradual development of medical level and the adjustment of medical insurance policy, ECMO in China began to develop rapidly. At the end of 2019, the novel coronavirus pneumonia (COVID-19) broke out, and ECMO was used in the treatment of severe COVID-19 patients, which began to enter the public's attention. In addition, due to its important role in the treatment of the novel coronavirus epidemic, the National Health Commission listed ECMO as an important treatment technology for critically ill patients with novel coronavirus pneumonia in the Diagnosis and Treatment Plan, which greatly promoted domestic medical institutions to further carry out ECMO-related training and study and set up ECMO centers. In January 2023, domestic extracorporeal membrane oxygenation (ECMO) products were approved for market. As a result, China has become the fourth country in the world that can independently produce ECMO complete systems after the United States, Germany and Italy.

2. ECMO Development Status

The clinical application of ECMO has advanced rapidly in recent years. Worldwide, according to ELSO statistics, there were 488 ECMO centers worldwide in 2019, with 17,078 cases of ECMO implementation, and statistics as of October 2021 show that the number of registered ECMO centers in 2020 increased to 521, with 18,260 cases carried out throughout the year. A total of 154,106 ECMO cases were performed, and 54% of patients survived to discharge or transfer to hospital [6]. From the perspective of ECMO center distribution, ECMO centers, especially high-level ECMO centers, are mainly concentrated in North America and Europe.

In June 2024, it commissioned the heads of 33 provinces, municipalities directly under the Central Government, autonomous regions, and special administrative regions (excluding Taiwan) to investigate the data of Extracorporeal life support in each province from January 1, 2023 to December 31, 2023. It included the number of ECMO cases performed at each extracorporeal life support center, indications (respiratory support, circulatory support and external cardiopulmonary resuscitation (ECPR)), and the survival rate of patients with different indications. A total of 814 hospitals reported a total of 18,486 ECMO cases in 2023, an increase of 37.0% over 2022 (13,491 cases).