• Meconium aspiration syndrome.

• Congenital diaphragmatic hernia.

• Idiopathic pulmonary hypertension.

• Severe, reversible respiratory failure.

• Cardiac disease.

• Preterm infants (< 34 weeks).

• Small infants(< 2 kg) because of the increased risk of hemorrhage during heparinization.

• Significant intracranial hemorrhage.

• Lethal anomalies (eg, trisomy 18).

• Extracorporeal membrane oxygenation (ECMO) bypass circuit (Figure 71–1), which includes the following:

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  • Large vascular catheters.

  
  

  • Servo-regulated pump.

  
  

  • Silicone membrane artificial lung.

  
  

  • Heat exchanger.

• The UK Collaborative ECMO Trial Group demonstrated that ECMO decreased mortality (32% vs. 59%) and reduced severe disability at 1 year of age (33% vs. 62%).

• There are no universally accepted criteria for referral and initiation of ECMO; rather each center develops its own criteria based on experience.

• Infants are cannulated for ECMO when their mortality is predicted to be 80% or greater.

• Most centers factor in the severity of hypoxemia, the level of respiratory support, and severity of cardiac failure into the decision-making process.

• An important consideration is reversibility of lung disease.

• Infants who have received prolonged mechanical ventilation and exposure to high oxygen concentrations (more than 10–14 days) may be excluded from consideration due to concerns about irreversible lung injury.

• Therefore, discussion with an ECMO center should occur relatively early in the disease process.