Recent medical advances, such as permissive hypercapnia, inhaled nitric oxide, and the use of oscillatory ventilation, have spared numerous patients from ECMO, yet many children still benefit from this modality. Patients with reversible cardiopulmonary disease, who meet criteria, should be considered ECMO candidates. As of January 2015, 27,728 neonates (74% survival) and 6,569 pediatric patients (57% survival) have been treated with ECMO for respiratory failure and 13,124 neonatal and pediatric patients for cardiac failure. ECMO provides an excellent opportunity to provide “rest” to the cardiopulmonary systems thus avoiding the additional lung or cardiac injury which otherwise would be necessary to maintain life support. This chapter outlines the indications, contraindications, management approach, and complications associated with ECMO as well as the various bypass configurations and cannulation strategies which may be employed.
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Bailly DK, Reeder RW, Zabrocki LA, Hubbard AM, Wilkes J, Bratton SL, Thiagarajan RR. Extracorporeal life support organization member centers. Development and validation of a score to predict mortality in children undergoing extracorporeal membrane oxygenation for respiratory failure: pediatric pulmonary rescue with extracorporeal membrane oxygenation prediction score. Crit Care Med. 2017;45(1):e58–66.CrossRefGoogle Scholar
Barbaro RP, Bartlett RH, Chapman RL, et al. Development and validation of the neonatal risk estimate score for children using extracorporeal respiratory support. J Pediatr. 2016;173:56–61.e3.CrossRefGoogle Scholar
Bartlett RH, Roloff DW, Cornell RG, et al. Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study. Pediatrics. 1985;76(4):479–87.PubMedGoogle Scholar
Butler DF, Lee B, Molitor-Kirsch E, Newland JG. Extracorporeal membrane oxygenation associated bloodstream infections in children. Pediatr Infect Dis J. 2017;36:346–347.CrossRefGoogle Scholar
Campbell BT, Braun TM, Schumacher RE, et al. Impact of ECMO on neonatal mortality in Michigan (1980–1999). J Pediatr Surg. 2003;38:290–5.CrossRefGoogle Scholar
Extracorporeal Life Support Organization International Registry Report of the Extracorporeal Life Support Organization. 2015. University of Michigan Medical Center, Ann Arbor.Google Scholar
Frenckner B. Extracorporeal membrane oxygenation: a breakthrough for respiratory failure. J Intern Med. 2015;278(6):586–98.CrossRefGoogle Scholar
Hirschl RB, Bartlett RH. Extracorporeal life support in cardiopulmonary failure. In: Coran AG, Adzick NS, Krummerl T, Laberge JM, Shamberger R, Caldamone A, editors. Pediatric surgery. 5th ed. New York: Mosby; 2012. p. 89–102.Google Scholar
McHoney M, Hammond P. Role of ECMO in congenital diaphragmatic hernia. Arch Dis Child Fetal Neonatal Ed. 2018;103(2):F178–81.CrossRefGoogle Scholar
Madderom MJ, Reuser JJ, Utens EM, et al. Neurodevelopmental, educational and behavioral outcome at 8 years after neonatal ECMO: a nationwide multicenter study. Intensive Care Med. 2013;39(9):1584–93.CrossRefGoogle Scholar
Schiller RM, Madderom MJ, Reuser JJ, et al. Neuropsychological follow-up after neonatal ECMO. Pediatrics. 2016;138(5):e20161313.CrossRefGoogle Scholar