Extracorporeal membrane oxygenation in neonates.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO), originally developed as an artificial replacement for respiratory assistance, is decreasingly used in neonates with respiratory failure. Nevertheless, there is a constant need for this invasive and expensive neonatal treatment modality.

INTERVENTION: Review of our experience (80 recent ECMO performances because of circulatory failure) and the literature.

RESULTS: In contrary to reduced ECMO performances out of respiratory insufficiency in neonates, ECMO as circulatory support is increasingly used. Neonatal sepsis, pre- and postoperative cardiac failure, combined circulatory and respiratory failure after resuscitation and with congenital diaphragmatic hernia result in a permanent need for ECMO, whenever there are fewer ECMO treatments per year. Nonocclusive pumps, portable devices, small priming volumes and tapered anticoagulation protocols enable survival through ECMO even in virtually hopeless hemodynamic conditions. Special efforts in investigation and prevention of permanent neurological impairment, especially after severe pre-ECMO hypoxia seem to be mandatory.

CONCLUSION: ECMO remains an important tool in neonatal and pediatric intensive care. However, the number of ECMO therapies was reduced due to respiratory therapeutic progress, but indications and ECMO technology have changed.