Extracorporeal membrane oxygenation for pediatric respiratory failure: History, development and current status

Table 1 Extracorporeal membrane oxygenation limitations and advantages comparing veno venous to veno arterial support

Factors	Veno venous	Veno arterial
Systemic emboli	Lower rate unless intra cardiac shunt present	Increased rate of stroke and seizures with carotid cannulation, risk increases with patient age
		Limb ischemia with femoral arterial cannulation
Cardiopulmonary support	Does not provide direct hemodynamic support	Provides full hemodynamic support
	Lower systemic oxygenation	High systemic oxygenation
	Increased rate of hypertension during ECMO	Non pulsatile flow
	Usually requires some degree of pulmonary gas exchange and lung recruitment	More commonly used with severe air leak
	Indirect support with more oxygenated blood provided to pulmonary circulation
Organ injury	Less acute kidney injury- preserved pulsatile blood flow	More acute kidney injury
	Less central nervous system injury risk	More central nervous system injury risk
Monitoring	Mixed venous oxygen saturation less reliable due to recirculation	Reliable mixed venous saturation measurements
Bleeding	Increased cannula site bleeding	More bleeding with multiple site cannulation and femoral arterial cannulation compared to carotid
Infection	Less risk with percutaneous and single cannula use	Greater rates of infection
Rehabilitation	Less sedation use if adequate oxygen delivery possible
	Mobilization of patients more feasible with single catheter neck catheter

ECMO: Extracorporeal membrane oxygenation.

Table 2 Factors associated with hospital mortality among pediatric patients receiving extracorporeal membrane oxygenation for respiratory failure

Factors	Increased survival	Increased death
Age	Younger	Age > 10 yr
Pulmonary process	Asthma	Pertussis
	Viral pneumonia/bronchiolitis	Sepsis
	Aspiration pneumonia	Opportunistic infections
Organ dysfunction		Renal failure/dialysis
		Liver injury
		Immune impairment/deficiency
		Cardiac arrest prior to ECMO
Severity of ventilator associated lung injury prior to ECMO		Severe acidosis
		High mean airway pressure
		Duration ventilation > 14 d
Mode	VV	VA
Complications during ECMO		Infection
		Stroke
		Cardiac arrest
		Organ failure

VV: Veno venous; VA: Veno arterial; ECMO: Extracorporeal membrane oxygenation.