Particularities of ECMO in Acute Respiratory Distress Syndrome in Pediatrics

Since the 80' s, extracorporeal techniques have been used in pediatrics for the most severe acute respiratory distress syndromes. In 2012, data from the International Register of the Extracorporeal Life Support Organization revealed that more than 5,000 children had undergone extracorporeal membrane oxygenation (ECMO) with an increase in the number of annual cases since the epidemics of 2009. The survival rate (56%) is stable while the number of children with comorbidities increases due to the improvements in the equipment. Although there are no randomized studies, results encourage considering ECMO in pediatric ARDS. If veno-venous ECMO should be preferred in respiratory diseases, veno-arterial ECMO may be necessary and is still used frequently in children (50% of cases). In pediatrics, the technical features are first related to the physiological characteristics of the child and secondly to the technical limitations of the available equipment in the different ages. ECMO is a technique requiring specific expertise and specialized pediatric teams due to children's particularities.