Extracorporeal Membrane Oxygenation Machine
Extracorporeal Membrane Oxygenation Machine Market by Modality (Arteriovenous ECMO, Venoarterial ECMO, Venovenous ECMO), Age (Adult, Neonate, Pediatric), Component, Application, End-User - Global Forecast 2024-2030
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[188 Pages Report] The Extracorporeal Membrane Oxygenation Machine Market size was estimated at USD 794.86 million in 2023 and expected to reach USD 832.14 million in 2024, at a CAGR 4.55% to reach USD 1,085.63 million by 2030.

Extracorporeal membrane oxygenation machines are medical devices that provide prolonged cardiac & respiratory support for patients whose hearts and lungs cannot provide adequate gas exchange to sustain life. These machines extract blood from the patient’s body, oxygenate it through an artificial lung (the membrane), remove carbon dioxide, and then return it to the patient’s bloodstream. This external life support system takes over the function of the heart and lungs, allowing these organs to rest and heal during critical illness. The surging prevalence of cardiovascular and respiratory diseases and technological advancements that improve patient outcomes have increased the adoption of ECMO systems. Additionally, improvements in healthcare infrastructure and increased healthcare spending are contributing to the market expansion. High costs associated with ECMO procedures and a limited number of trained healthcare professionals to operate these machines represent a challenge for market growth. Nevertheless, advancements in ECMO machine design to enhance portability and ease of use in different treatment settings are expected to provide opportunistic scope for the market. Moreover, ECMO integration with other extracorporeal therapies and research activities focused on expanding the indications for ECMO support is expected to boost the market.

Regional Insights

In the Americas region, extracorporeal membrane oxygenation machines have seen significant growth driven by the high incidence rates of cardiovascular and respiratory diseases, a well-established healthcare infrastructure system, and the availability of skilled professionals. Additionally, the region has seen a surge in ECMO utilization due to the COVID-19 pandemic, further fueling market expansion. Increased funding for research and development, coupled with technological advancements, continues to enhance ECMO system capabilities, making them more efficient and user-friendly for critical care adoption. The market landscape for ECMO machines in the EMEA region exhibits steady growth. In Europe, the demand for ECMO support is influenced by rising healthcare expenditures, an aging population, and the prevalence of lifestyle-associated diseases. Major economies are implementing ECMOs due to their advanced healthcare systems and policies that favor adopting medical devices. The Asia-Pacific region shows high-growth prospects for ECMO machines. Economic development, increasing healthcare expenditure, and a growing population base are pivotal forces propelling market growth. Major economies are investing heavily in upgrading their healthcare infrastructure. Moreover, the boosting medical tourism industry in some economies is also opening new avenues for the ECMO machines market.

Extracorporeal Membrane Oxygenation Machine Market
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Market Dynamics

The market dynamics represent an ever-changing landscape of the Extracorporeal Membrane Oxygenation Machine Market by providing actionable insights into factors, including supply and demand levels. Accounting for these factors helps design strategies, make investments, and formulate developments to capitalize on future opportunities. In addition, these factors assist in avoiding potential pitfalls related to political, geographical, technical, social, and economic conditions, highlighting consumer behaviors and influencing manufacturing costs and purchasing decisions.

  • Market Drivers
    • Prevalence of cardiovascular and respiratory diseases
    • Adoption of ECMO for neonatal care and expansion of ECMO centers
  • Market Restraints
    • Adverse recalls of ECMO machines
  • Market Opportunities
    • Ongoing advancements in ECMO machines
    • Improving reimbursement scenario for ECMO machines worldwide
  • Market Challenges
    • Potential complexity associated with the operation and maintenance of ECMO
Market Segmentation Analysis
  • Modality: Rising utilization of venoarterial ECMO as it provides both cardiac and respiratory support

    Arteriovenous extracorporeal membrane oxygenation (AV ECMO) is an older method of ECMO support that utilizes the patient's arterial and venous blood flow to drive blood through the ECMO circuit. In AV ECMO, blood is drawn from an artery and returned to a vein after oxygenation. This technique relies on the patient's heart to pump blood through the oxygenator. It is less commonly used in modern ECMO therapy due to advancements in technology that prefer other modes for efficiency and safety. Venoarterial extracorporeal membrane oxygenation (VA ECMO) provides both cardiac and respiratory support by withdrawing venous blood, which is then oxygenated outside of the body and infused back into an artery. VA ECMO is used in cases of severe heart failure or cardiac arrest because it bypasses both the heart and the lungs, thus providing full support to these organs. The cannulation is usually done through the large central vessels, such as the femoral or carotid artery and vein. VA ECMO is utilized primarily for respiratory support, where blood is removed from a large vein, oxygenated through the ECMO circuit, and returned to a vein. This mode of ECMO ensures adequate oxygenation when the lungs are severely compromised by conditions including acute respiratory distress syndrome (ARDS) or pneumonia. The typical cannulation sites for VV ECMO include the internal jugular and femoral veins.

  • Age: Increasing need for ECMO machines in adults owing to respiratory & cardiac disorders

    Adult patients who require ECMO therapy suffer from severe respiratory or cardiac conditions that are unresponsive to conventional management. These include conditions such as acute respiratory distress syndrome (ARDS), cardiogenic shock, or pulmonary embolism. Adult ECMO machines are designed to manage larger blood flow with durable components that can withstand extended use. Neonates require ECMO support due to conditions present at birth, such as congenital diaphragmatic hernia or meconium aspiration syndrome. Neonatal ECMO machines are designed to handle the delicate and minimal blood volume of newborns with precise control and gentle flow to minimize the risk of hemolysis or other blood-related complications. The primary distinction for neonatal ECMO machines is the focus on reducing invasiveness and limiting the extracorporeal circuit volume to suit the patient’s size. The machines also have smaller cannulae and specialized circuits than those used for older children and adults. Pediatric patients, ranging from infants to older children, may require ECMO due to various respiratory and cardiac failures that are unresponsive to standard treatment. Pediatric ECMO machines must be versatile to accommodate the wide age and size range of patients in this group, with adjustability in flow rates and oxygenator sizes.

  • Component: Increasing need for durable and biocompatible oxygenators for ECMO machines

    Anticoagulation systems are integral to the ECMO setup, preventing blood from clotting as it travels outside the body through the ECMO circuit. Blenders in ECMO machines mix air with pure oxygen, delivering controlled oxygen levels to the patient. Blenders must offer adjustable oxygen concentration ranges to cater to varying patient needs. Cannulae are conduits for blood flow between the patient and the ECMO machine, which come in various sizes and materials tailored to specific patient anatomy and surgical requirements. Heat exchangers regulate the blood temperature during ECMO therapy, crucial for maintaining the patient’s core temperature. Monitoring systems are critical for overseeing the patient's vitals and the ECMO machine's performance. The oxygenator is the heart of the ECMO machine, where gas exchange occurs. Manufacturers are currently producing oxygenators that maximize gas exchange efficiency while minimizing blood trauma. The pump propels blood through the ECMO circuit, and centrifugal and roller pumps are the two primary pumps in ECMO machines. Centrifugal pumps are preferred for their lower hemolysis rates, while roller pumps are favored for their simplicity and cost-effectiveness.

  • Application: Proliferating usage of Extracorporeal Cardiopulmonary Resuscitation (ECPR) as it quickly restores oxygenated blood flow to vital organs

    ECMO machines are widely used in cardiac applications as a life-supporting bridge for patients experiencing severe heart failure or during high-risk cardiac procedures. When used this way, the ECMO machine takes over the heart's function to oxygenate the blood and sustain systemic circulation, giving the patient's heart time to rest and recover or be repaired. This is particularly crucial during postcardiotomy cardiogenic shock or cardiac transplantation when the heart may not immediately sustain circulation. Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an emerging technique where ECMO is employed alongside conventional CPR in cases of cardiac arrest, especially when the standard resuscitation efforts do not lead to a return of spontaneous circulation. ECPR can quickly restore oxygenated blood flow to vital organs, thus extending the timeframe for successful resuscitation and reducing the risk of neurological damage due to prolonged oxygen deprivation. It represents a valuable option in environments that facilitate rapid deployment, such as in specialized cardiac centers where time-sensitive interventions can be critical to patient survival. In respiratory applications, ECMO is a pivotal treatment modality for patients experiencing severe and potentially reversible respiratory failure that is not responsive to conventional management, including mechanical ventilation. Conditions including acute respiratory distress syndrome (ARDS), severe pneumonia, or pulmonary embolism may warrant the use of ECMO. The ECMO system allows the lungs to rest while minimizing ventilator-induced lung injury by providing adequate oxygenation and removing carbon dioxide. The ECMO system has played a pivotal role in managing critical respiratory conditions, including during outbreaks of infectious diseases such as the H1N1 influenza and COVID-19.

  • End-User: Development of advanced ECMO machines to cater to dedicated intensive care units in hospitals

    Ambulatory surgical centers (ASCs) are healthcare facilities that provide same-day surgical care, including diagnostic and preventive procedures. The preference for ECMO machines in ASCs is based on the need to provide prompt respiratory or cardiac support for high-risk patients during complex surgeries or in the immediate postoperative period. This includes patients anticipated to require only a brief duration of ECMO support or those with specific needs that can be addressed rapidly without an extended hospital stay. Hospitals serve as the primary end-user segment for ECMO machines due to the comprehensive and varied levels of patient care they provide, including intensive care units where ECMO machines are most commonly utilized. Hospitals mainly use ECMO machines for patients requiring extended cardiac and respiratory support that cannot be adequately delivered through conventional ventilation or medication. Hospitals generally have greater infrastructure and resources to manage complex ECMO cases than ASCs or specialty clinics. Specialty clinics are outpatient facilities that focus on specific healthcare services, which may include providing ECMO treatment. Specialty clinics may employ ECMO machines to provide targeted support for patients with complex but stable cardiac or respiratory conditions that do not require the extensive resources of a hospital setting. The preference for ECMO machines in this setting is for a focused approach to treatment, offering advanced care to patients with specific needs.

Market Disruption Analysis

The market disruption analysis delves into the core elements associated with market-influencing changes, including breakthrough technological advancements that introduce novel features, integration capabilities, regulatory shifts that could drive or restrain market growth, and the emergence of innovative market players challenging traditional paradigms. This analysis facilitates a competitive advantage by preparing players in the Extracorporeal Membrane Oxygenation Machine Market to pre-emptively adapt to these market-influencing changes, enhances risk management by early identification of threats, informs calculated investment decisions, and drives innovation toward areas with the highest demand in the Extracorporeal Membrane Oxygenation Machine Market.

Porter’s Five Forces Analysis

The porter's five forces analysis offers a simple and powerful tool for understanding, identifying, and analyzing the position, situation, and power of the businesses in the Extracorporeal Membrane Oxygenation Machine Market. This model is helpful for companies to understand the strength of their current competitive position and the position they are considering repositioning into. With a clear understanding of where power lies, businesses can take advantage of a situation of strength, improve weaknesses, and avoid taking wrong steps. The tool identifies whether new products, services, or companies have the potential to be profitable. In addition, it can be very informative when used to understand the balance of power in exceptional use cases.

Value Chain & Critical Path Analysis

The value chain of the Extracorporeal Membrane Oxygenation Machine Market encompasses all intermediate value addition activities, including raw materials used, product inception, and final delivery, aiding in identifying competitive advantages and improvement areas. Critical path analysis of the <> market identifies task sequences crucial for timely project completion, aiding resource allocation and bottleneck identification. Value chain and critical path analysis methods optimize efficiency, improve quality, enhance competitiveness, and increase profitability. Value chain analysis targets production inefficiencies, and critical path analysis ensures project timeliness. These analyses facilitate businesses in making informed decisions, responding to market demands swiftly, and achieving sustainable growth by optimizing operations and maximizing resource utilization.

Pricing Analysis

The pricing analysis comprehensively evaluates how a product or service is priced within the Extracorporeal Membrane Oxygenation Machine Market. This evaluation encompasses various factors that impact the price of a product, including production costs, competition, demand, customer value perception, and changing margins. An essential aspect of this analysis is understanding price elasticity, which measures how sensitive the market for a product is to its price change. It provides insight into competitive pricing strategies, enabling businesses to position their products advantageously in the Extracorporeal Membrane Oxygenation Machine Market.

Technology Analysis

The technology analysis involves evaluating the current and emerging technologies relevant to a specific industry or market. This analysis includes breakthrough trends across the value chain that directly define the future course of long-term profitability and overall advancement in the Extracorporeal Membrane Oxygenation Machine Market.

Patent Analysis

The patent analysis involves evaluating patent filing trends, assessing patent ownership, analyzing the legal status and compliance, and collecting competitive intelligence from patents within the Extracorporeal Membrane Oxygenation Machine Market and its parent industry. Analyzing the ownership of patents, assessing their legal status, and interpreting the patents to gather insights into competitors' technology strategies assist businesses in strategizing and optimizing product positioning and investment decisions.

Trade Analysis

The trade analysis of the Extracorporeal Membrane Oxygenation Machine Market explores the complex interplay of import and export activities, emphasizing the critical role played by key trading nations. This analysis identifies geographical discrepancies in trade flows, offering a deep insight into regional disparities to identify geographic areas suitable for market expansion. A detailed analysis of the regulatory landscape focuses on tariffs, taxes, and customs procedures that significantly determine international trade flows. This analysis is crucial for understanding the overarching legal framework that businesses must navigate.

Regulatory Framework Analysis

The regulatory framework analysis for the Extracorporeal Membrane Oxygenation Machine Market is essential for ensuring legal compliance, managing risks, shaping business strategies, fostering innovation, protecting consumers, accessing markets, maintaining reputation, and managing stakeholder relations. Regulatory frameworks shape business strategies and expansion initiatives, guiding informed decision-making processes. Furthermore, this analysis uncovers avenues for innovation within existing regulations or by advocating for regulatory changes to foster innovation.

FPNV Positioning Matrix

The FPNV positioning matrix is essential in evaluating the market positioning of the vendors in the Extracorporeal Membrane Oxygenation Machine Market. This matrix offers a comprehensive assessment of vendors, examining critical metrics related to business strategy and product satisfaction. This in-depth assessment empowers users to make well-informed decisions aligned with their requirements. Based on the evaluation, the vendors are then categorized into four distinct quadrants representing varying levels of success, namely Forefront (F), Pathfinder (P), Niche (N), or Vital (V).

Market Share Analysis

The market share analysis is a comprehensive tool that provides an insightful and in-depth assessment of the current state of vendors in the Extracorporeal Membrane Oxygenation Machine Market. By meticulously comparing and analyzing vendor contributions, companies are offered a greater understanding of their performance and the challenges they face when competing for market share. These contributions include overall revenue, customer base, and other vital metrics. Additionally, this analysis provides valuable insights into the competitive nature of the sector, including factors such as accumulation, fragmentation dominance, and amalgamation traits observed over the base year period studied. With these illustrative details, vendors can make more informed decisions and devise effective strategies to gain a competitive edge in the market.

Recent Developments
  • The Government of New South Wales (NSW)’s New Innovative Clinical Trial with Mobile Cardiac Treatment

    The New South Wales (NSW) Government invested significantly in the healthcare sector by allocating funds to acquire state-of-the-art Extracorporeal Membrane Oxygenation (ECMO) machines. These sophisticated devices offer critical life support to patients experiencing severe heart and lung failure, effectively substituting their functions to allow for recovery or while awaiting a transplant. This initiative aligns with the NSW Government's commitment to providing advanced medical treatments and improving patient outcomes across the state. [Published On: 2023-11-15]

  • Inspira Technologies Unveils the INSPIRA ART Line of Medical Devices at the World's Largest Extracorporeal Life Support Conference

    Inspira Technologies OXY B.H.N. Ltd. introduced its INSPIRA ART product suite during the Extracorporeal Life Support Organization (ELSO) Conference held in Seattle, Washington. This lineup features the innovative INSPIRA ART100, a cardio-pulmonary bypass (CPB) apparatus designed to support patients undergoing CPB interventions. The suite also showcases the INSPIRA ART500, a groundbreaking device engineered to transform the treatment landscape for approximately 20 million individuals who struggle with severe breathing complications annually. [Published On: 2023-09-28]

  • AIIMS-R Starts ECMO Treatment

    AIIMS Raipur commenced the provision of Extracorporeal Membrane Oxygenation (ECMO) therapy, a sophisticated life support intervention, catering to patients with severe and life-threatening illnesses affecting the heart and lungs. This cutting-edge medical procedure offers a critical lifeline by oxygenating a patient's blood outside the body, thus allowing the heart and lungs to rest and heal. Implementing ECMO services at AIIMS Raipur signifies a substantial advancement in the region's healthcare facilities. It extends a beacon of hope to critically ill patients who previously had limited access to such high-end treatment options. [Published On: 2023-09-12]

Strategy Analysis & Recommendation

The strategic analysis is essential for organizations seeking a solid foothold in the global marketplace. Companies are better positioned to make informed decisions that align with their long-term aspirations by thoroughly evaluating their current standing in the Extracorporeal Membrane Oxygenation Machine Market. This critical assessment involves a thorough analysis of the organization’s resources, capabilities, and overall performance to identify its core strengths and areas for improvement.

Key Company Profiles

The report delves into recent significant developments in the Extracorporeal Membrane Oxygenation Machine Market, highlighting leading vendors and their innovative profiles. These include Abbott Laboratories, Abiomed, Inc., Baxter International Inc., Braile Biomédica, Chalice Medical Ltd., CytoSorbents Corporation, Dragerwerk AG & Co. KGaA, Eurosets S.R.L., Getinge AB, Guangdong Pigeon Medical Apparatus Co.,Ltd., Hengko Technology Co., Ltd., Inspira Technologies OXY B.H.N. Ltd., LivaNova PLC, MC3 Cardiopulmonary, Medtronic PLC, MicroPort Scientific Corporation, Nipro Corporation, Origen Biomedical, Inc., Owgels Group, Senko Medical Instrument Mfg. Co., Ltd., Shenzhen Mindray Biomedical Electronics Co. Ltd., Technimount System, Terumo Corporation, XENIOS AG by Fresenius Medical Care AG & Co. KGaA, and ZOLL Medical Corporation by Asahi Kasei Corporation.

Extracorporeal Membrane Oxygenation Machine Market - Global Forecast 2024-2030
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Market Segmentation & Coverage

This research report categorizes the Extracorporeal Membrane Oxygenation Machine Market to forecast the revenues and analyze trends in each of the following sub-markets:

  • Modality
    • Arteriovenous ECMO
    • Venoarterial ECMO
    • Venovenous ECMO
  • Age
    • Adult
    • Neonate
    • Pediatric
  • Component
    • Anticoagulation Systems
    • Blender
    • Cannulae
    • Heat Exchanger
    • Monitoring Systems
    • Oxygenator
    • Pump
  • Application
    • Cardiac Application
    • Extracorporeal Cardiopulmonary Resuscitation
    • Respiratory Application
  • End-User
    • Ambulatory Surgical Centers
    • Hospitals
    • Specialty Clinics

  • Region
    • Americas
      • Argentina
      • Brazil
      • Canada
      • Mexico
      • United States
        • California
        • Florida
        • Illinois
        • New York
        • Ohio
        • Pennsylvania
        • Texas
    • Asia-Pacific
      • Australia
      • China
      • India
      • Indonesia
      • Japan
      • Malaysia
      • Philippines
      • Singapore
      • South Korea
      • Taiwan
      • Thailand
      • Vietnam
    • Europe, Middle East & Africa
      • Denmark
      • Egypt
      • Finland
      • France
      • Germany
      • Israel
      • Italy
      • Netherlands
      • Nigeria
      • Norway
      • Poland
      • Qatar
      • Russia
      • Saudi Arabia
      • South Africa
      • Spain
      • Sweden
      • Switzerland
      • Turkey
      • United Arab Emirates
      • United Kingdom

This research report offers invaluable insights into various crucial aspects of the Extracorporeal Membrane Oxygenation Machine Market:

  1. Market Penetration: This section thoroughly overviews the current market landscape, incorporating detailed data from key industry players.
  2. Market Development: The report examines potential growth prospects in emerging markets and assesses expansion opportunities in mature segments.
  3. Market Diversification: This includes detailed information on recent product launches, untapped geographic regions, recent industry developments, and strategic investments.
  4. Competitive Assessment & Intelligence: An in-depth analysis of the competitive landscape is conducted, covering market share, strategic approaches, product range, certifications, regulatory approvals, patent analysis, technology developments, and advancements in the manufacturing capabilities of leading market players.
  5. Product Development & Innovation: This section offers insights into upcoming technologies, research and development efforts, and notable advancements in product innovation.

Additionally, the report addresses key questions to assist stakeholders in making informed decisions:

  1. What is the current market size and projected growth?
  2. Which products, segments, applications, and regions offer promising investment opportunities?
  3. What are the prevailing technology trends and regulatory frameworks?
  4. What is the market share and positioning of the leading vendors?
  5. What revenue sources and strategic opportunities do vendors in the market consider when deciding to enter or exit?

Table of Contents
  1. Preface
  2. Research Methodology
  3. Executive Summary
  4. Market Overview
  5. Market Insights
  6. Extracorporeal Membrane Oxygenation Machine Market, by Modality
  7. Extracorporeal Membrane Oxygenation Machine Market, by Age
  8. Extracorporeal Membrane Oxygenation Machine Market, by Component
  9. Extracorporeal Membrane Oxygenation Machine Market, by Application
  10. Extracorporeal Membrane Oxygenation Machine Market, by End-User
  11. Americas Extracorporeal Membrane Oxygenation Machine Market
  12. Asia-Pacific Extracorporeal Membrane Oxygenation Machine Market
  13. Europe, Middle East & Africa Extracorporeal Membrane Oxygenation Machine Market
  14. Competitive Landscape
  15. Competitive Portfolio
  16. List of Figures [Total: 26]
  17. List of Tables [Total: 474]
  18. List of Companies Mentioned [Total: 25]
The Scope of Extracorporeal Membrane Oxygenation Machine in Treating Cardiovascular and Respiratory Diseases
January 5, 2024
BLOG
The Scope of Extracorporeal Membrane Oxygenation Machine in Treating Cardiovascular and Respiratory Diseases
The rising incidence of cardiovascular and respiratory diseases has brought about the need for advanced treatment methods that can help patients with severe conditions. Extracorporeal Membrane Oxygenation (ECMO) machines are advanced medical devices that have significantly impacted the healthcare sector by providing advanced life support to patients with critical respiratory and cardiac failure. ECMO machines have played a vital role in saving countless lives, and their effectiveness in treating severe cases has made them a first-line treatment option for many healthcare providers. This blog explores the scope of ECMO machines in treating cardiovascular and respiratory diseases and their critical role in the healthcare system.

ECMO machines are devices that help provide oxygenation and carbon dioxide removal by temporarily replacing the function of the lungs or heart. These machines work by circulating the blood outside the body, passing through an artificial membrane oxygenator that removes carbon dioxide and adds oxygen before returning the blood to the body. The ECMO circuit works similarly to the natural pulmonary or cardiovascular circuit, providing support for the organ that is unable to function correctly. ECMO machines can provide oxygenation or cardiac support, depending on the patient's condition.

ECMO machines have significantly impacted the treatment of acute respiratory distress syndrome (ARDS) and acute respiratory failure, especially in patients with severe respiratory failure. These machines have also been used to provide organ support for patients undergoing heart or lung transplants or waiting for organ transplantation.

Advancements in ECMO technology have played a vital role in improving patient outcomes and reducing mortality rates. Newer ECMO machines are designed to be more portable, allowing clinicians to provide life support anywhere, from the emergency room to the intensive care unit. The use of handheld devices has made ECMO machines more accessible to patients, and it has also reduced the need for patients to be transported to specialized centers.

Despite the numerous benefits of ECMO machines, their use is still limited due to the high cost of the devices and the associated infrastructure required. In addition, ECMO is an invasive procedure that requires specialized training and expertise to perform safely. The high cost of ECMO machines limits their accessibility to patients in low-income countries, and the lack of training and expertise limits the use of the device in many healthcare centers.

ECMO machines have become an essential tool for healthcare providers in the treatment of severe respiratory and cardiac failure. These machines have significantly improved patient outcomes, reducing the mortality rate in patients with severe respiratory and cardiac disease. Advancements in ECMO technology have made the machines more accessible, portable, and easier to use, reducing the barrier to entry and making them more accessible to patients.

Frequently Asked Questions
  1. How big is the Extracorporeal Membrane Oxygenation Machine Market?
    Ans. The Global Extracorporeal Membrane Oxygenation Machine Market size was estimated at USD 794.86 million in 2023 and expected to reach USD 832.14 million in 2024.
  2. What is the Extracorporeal Membrane Oxygenation Machine Market growth?
    Ans. The Global Extracorporeal Membrane Oxygenation Machine Market to grow USD 1,085.63 million by 2030, at a CAGR of 4.55%
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