ABSTRACT

The provision of mechanical circulatory support when other forms of treatment have failed is increasingly common in the therapeutic approach to patients with cardiac disease. For adults in the acute setting, left ventricular failure due to coronary artery disease has been managed with intraaortic balloon pumping (IABP) and left ventricular assist device (LVAD) insertion. For chronic circulatory support, the success of implantable LVAD systems has led to their increasing use in the management of patients with end-stage ventricular failure. In children, however, isolated left ventricular failure is relatively rare, while right ventricular failure, pulmonary hypertension, and hypoxemia often contribute significantly to circulatory failure in pediatric heart disease. Due to these physiological differences isolated support of the left ventricle by IABP or LVAD has more limited application in children. Extracorporeal membrane oxygenation (ECMO) provides biventricular cardiopulmonary support and has emerged as the dominant modality of mechanical circulatory assistance in children with heart disease who have failed conventional medical treatment. This chapter will address the current status of ECMO in these patients by examining historical aspects of its development, technical issues related to management of the circuit, and unique clinical features of pediatric cardiac ECMO such as indications and contraindications for support.

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II. HISTORICAL ASPECTS