ABSTRACT
Extracorporeal membrane oxygenation (ECMO) is a life-
saving technology that uses partial heart/lung bypass for
extended periods of time. It is a supportive modality, rather
than a therapeutic tool, that provides gas exchange and
perfusion for neonates with an acute, reversible respiratory or
cardiac condition. During the time on ECMO, the patient’s
cardiopulmonary system is allowed to ‘rest’, thus being spared
from the potentially deleterious effects of high FiO2, high
airway pressure, traumatic mechanical ventilation, and
perfusion impairment. ECMO was first used in newborns
in 1974. Since then, the Extracorporeal Life Support
Organization (ELSO) has recorded approximately 28 000
newborns who have been supported with ECMO for a
variety of cardiorespiratory disorders. The most common
disorders in the newborn treated with ECMO are meconium
aspiration syndrome (MAS), persistent pulmonary hyperten-
sion of the neonate (PPHN), congenital diaphragmatic
hernia (CDH), sepsis, and cardiac support. Depending on
the indication for ECMO, the outcome is varied, but overall,
a survival rate of 80% has been reported for newborns treated
in this high (80%) mortality group.1 This chapter discusses the selection criteria for ECMO in neonates and the manage-
ment of these babies while on ECMO. It goes on to discuss
ECMO for use in difficult clinical scenarios, such as CDH,
and finally review outcome and follow up of neonates treated
with ECMO.
