• 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
• Significant intracranial hemorrhage.
• Lethal anomalies (eg, trisomy 18).
• 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
• 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
• Therefore, discussion with an ECMO center should occur relatively
early in the disease process.
• ECMO is only provided at highly specialized centers,
and most infants cannulated for ECMO must be transported from the
hospital of birth to the ECMO center.
• Therefore, the additional time and difficulty associated with
the transport should be taken into account when considering a referral
• Most often, the need for ECMO cannot be anticipated prior to
birth, and families require a great deal of support to understand
and cope with the unexpected severe illness of their infant.
• However, prenatal diagnosis of congenital diaphragmatic hernia
is often possible.
• Support is most often provided using a venoarterial
(VA) technique, meaning that catheters are inserted into the right
atrium and right common carotid artery.
• VA ECMO bypasses both the heart and lungs, providing both pulmonary
and cardiac support.
• Some infants can be supported with venovenous (VV) ECMO, in which
blood is removed and returned to the right atrium through a double-lumen
• VV ECMO does not provide cardiac support but can effectively
remove CO2 and deliver additional oxygen.
• Because contact of blood with the ECMO circuit activates the
clotting cascade, patients must receive systemic heparin.
• ECMO is continued until the lungs and heart recover.
• Care is provided by a specialized interdisciplinary team.
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