Extracorporeal membrane oxygenation in children

Children who require mechanical ventilation represent a high-risk population with significant morbidity and mortality. Experienced handling of conventional therapies including high frequency oscillation ventilation and initiation of newer treatment options such as surfactant or nitric oxide has led to some improvements. Nevertheless, extracorporeal membrane oxygenation (ECMO) is a life-saving technology in patients with respiratory failure refractory to maximal medical therapy. This article shows the therapeutic management and the selection criteria for ECMO in neonates and children based on the clinical signs of acquired and congenital diseases that can lead to respiratory failure. The distribution of diagnoses, survival rates, and demographic change of ECMO in newborns since the beginning of documentation in 1986 by the Extracorporeal Life Support Organization (ELSO) registry and the largest German ECMO Center Mannheim are described. Despite a changed diagnostic distribution in the direction of congenital pulmonary disease, the survival rate of ECMO in the neonates has remained well above 70 %. In pediatric ECMO, the survival rate has also remained constant despite a more complex patient population. The highest values are seen in the youngest patients without underlying disease. Despite limited evidence and relatively few randomized trials in children, ECMO remains the safety net for patients with severe respiratory failure. Experience as measured by the annual number of cases plays an important role for the quality of results.