Extracorporeal life support in pediatric patients

Abstract

Extracorporeal life support (ECLS) or extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for critically ill children with high mortality, cardiac and/or respiratory failure refractory to conventional intensive treatment. In the last decade, the use of ECLS in pediatric intensive care has rapidly grown. The clinical indications and contraindications for ECLS have changed dramatically. The given review describes the fundamentals of ECMO technology, main clinical indications for ECLS and outcomes of ECMO in neonates and children. ECMO has become the standard for treatment of refractory acute heart failure, cardiac arrest, severe acute respiratory distress syndrome against the background of a decreasing number of contraindications. Although ECMO may be used nowadays to support even smaller babies and those with far more serious pathologies, careful consideration of the risk factors and probable outcomes is very important for decision to initiate and continue ECMO. The use and management of ECLS widely varies between clinics. Further multicenter studies are required to optimize patient selection criteria, cannulation and ECMO management, to reduce the number of complications and to analyze the quality of life of patients after ECMO and the cost effectiveness.