Extracorporeal Membrane Oxygenation (ECMO)
Reagan Lindsay Ross
Extracorporeal membrane oxygenation (ECMO) remains the most commonly used form of pediatric mechanical circulatory support in the United States.
More than 3500 cases of pediatric cardiac ECMO have been registered in the Extracorporeal Life Support Organization.1,2,3,5
ECMO is used for short-term support, significantly limiting its effectiveness as a bridge to transplantation or recovery for children, particularly in infants with unrecoverable cardiac failure who require mechanical circulatory support often die if a donor heart does not become available in a few weeks.
As the pediatric circulatory support has increased, a greater number of devices for children have become available.
Currently available devices include ECMO, the Bio-Pump (Medtronic Corp., Minneapolis, Minnesota), the DeBakey VAD Child (MicroMed Cardiovascular, Inc., Houston, Texas), the Berlin Heart VAD (Berlin Heart Inc, The Woodlands, Texas), and a number of adult devices that have been successfully used in children (Figure 46.1).4,6
Each device offers certain advantages and limitations.
This chapter will focus primarily on ECMO, specifically, the history of ECMO, the ECMO system, and indications for use (Figure 46.2).
Additionally, the technique as well as multiorgan management during ECMO and mechanical and medical complications will be discussed.
HISTORY OF ECMO
In 1953 JH Gibbon Jr used an artificial oxygenation and perfusion support for the first open heart surgery.7
The following year, CW Lillehei developed a cross-circulation technique by using adult volunteers as live cardiopulmonary bypass apparatuses during the repair of congenital cardiac disorders.8,9
In 1965, Rashkind and colleagues were the first to use a bubble oxygenator as support in a neonate with respiratory failure.10
In 1969, Dorson and coworkers reported using a membrane oxygenator for cardiopulmonary bypass in infants.11
In 1970 Baffes et al reported successful use of ECMO in infants with congenital heart defects who underwent cardiac surgical intervention.12
Bartlett and colleagues were the first group to successfully use ECMO in neonates with severe respiratory distress in 197513.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
