Neonatal and paediatric extracorporeal membrane oxygenation

Most types of respiratory failure in the newborn are reversible, but supportive treatment can damage the lungs and airways. In the last decade prolonged extracorporeal membrane oxygenation (ECMO) has become an accepted technique, particularly in the neonatal group. We have placed 46 patients (26 neonates, 20 children) on ECMO for respiratory or cardiac support. The major indications in neonatal patients were congenital diaphragmatic hernia, persistent foetal circulation and meconium aspiration. The major indications in children were bacterial and viral pneumonias and systemic sepsis with respiratory failure. The hospital survival was 65% in the neonatal group and 40% in the paediatric group. The majority of neonatal deaths occurred in the group with congenital diaphragmatic hernia. In the other neonatal patients hospital survival was 74%. Carotid and jugular cannulation was the preferred technique, with vascular repair at the time of decannulation. Only one neonate and one child who have survived have a neurological or developmental deficit. We conclude that ECMO is most suitable for neonates with reversible lung disease, and congenital diaphragmatic hernia remains the major cause of death, due to pulmonary hypoplasia. The poorer results in children reflect the greater incidence of destructive and irreversible lung disease in this group, with associated systemic sepsis, multiorgan failure and coagulopathy from the primary disease.