Pathophysiology of respiratory failure and physiology of gas exchange during ECMO.

Lungs play a key role in sustaining cellular respiration by regulating the levels of oxygen and carbon dioxide in the blood. This is achieved by exchanging these gases between blood and ambient air across the alveolar capillary membrane by the process of diffusion. In the microstructure of the lung, gas exchange is compartmentalized and happens in millions of microscopic alveolar units. In situations of lung injury, this structural complexity is disrupted resulting in impaired gas exchange. Depending on the severity and the type of lung injury, different aspects of pulmonary physiology are affected. If the respiratory failure is refractory to ventilator support, extracorporeal membrane oxygenation (ECMO) can be utilized to support the gas exchange needs of the body. In ECMO, thin hollow fiber membranes made up of polymethylpentene act as blood-gas interface for diffusion. Decades of innovative engineering with membranes and their alignment with blood and gas flows has enabled modern oxygenators to achieve clinically and physiologically significant amount of gas exchange. © Indian Association of Cardiovascular-Thoracic Surgeons 2020.