Extracorporeal Membrane Oxygenation in Neonates

Introduction

Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving technology for newborns with refractory cardiopulmonary failure of reversible etiology. ECMO involves draining deoxygenated venous blood, extracorporeal gas exchange thereby oxygenating and removing carbon dioxide from the blood, and returning the blood via an infusion cannula either into a vein (venovenous ECMO) or artery (venoarterial ECMO; Fig. 82.1 ). Cannulation can be either peripheral, most commonly via the neck or femoral vessels, or central, usually via the right atrium and ascending aorta ( Fig. 82.2 ). In neonates, peripheral cannulation usually occurs via the internal jugular vein and carotid artery, because the femoral vessels are diminutive, technically challenging, and associated with greater complications. Dual lumen single-stage cannulas also exist, which have two separate lumens for infusion and drainage and are usually placed in the neck under fluoroscopic or echocardiographic guidance.

The use of ECMO in the neonatal population has expanded significantly since its inception in the early 1970s, due to a combination of improved technology, the expanding role of ECMO, and its encouraging outcomes. Indications for ECMO in the neonate can be broadly grouped into those that are intended to manage primary respiratory failure or cardiac failure or those following refractory cardiac arrest (extracorporeal cardiopulmonary resuscitation [ECPR]). This chapter uses the most recent literature to review current indications, applications, complications, and outcomes for ECMO in the neonate and discusses current controversies with respect to patient selection and ECMO management in this critically ill population.