ABSTRACT

Infants and childrenwith severe, acute, reversible cardiac, and respiratory failure face significant mortality. Failure to respond to conventional medical and pharmaceutical treatment leaves these patients with little recourse. These patients are candidates for extracorporeal life support (ECLS) or extracorporeal membrane oxygenation (ECMO). This invasive intervention is not a cure or a therapy, but a mechanism to provide cardiorespiratory support while the underlying pathophysiologic processes resolve with time, medical management, or surgical intercession. ECLS spares the body from the harmful effects of hypoxia, acidosis, barotrauma, and end-organ hypoperfusion as it struggles to recover. However, management of severely ill neonates and children with ECMO is associated with many complications, some of which have significant long-term consequences for the patient. The goal of this chapter is to review the techniques of ECMO cannulation in infants and children with attention to preventing known surgical complications, discuss the short-term mechanical and patient-related complications of ECMO, and examine the long-term outcomes of ECLS in the neonatal and pediatric populations.