• 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.