¹Division of Neonatology, Department of Pediatrics, Children's National Medical Center, The George Washington School of Medicine, Washington, DC, USA

Correspondence: Dr BL Short, Division of Neonatology, Department of Pediatrics, Children's National Medical Center, The George Washington School of Medicine, 111 Michigan Ave., NW, Washington, DC 20010, USA. E-mail: bshort@cnmc.org

Abstract

Extracorporeal membrane oxygenation (ECMO) has been successful as a rescue therapy for infants with respiratory failure with some diagnoses such as meconium aspiration syndrome (MAS) having a survival rate of more than 94%. New therapies have allowed many infants who would have required ECMO to be kept off ECMO, but at what cost. The survival rate for the neonatal ECMO patient has dropped over the years, whereas the time of ECMO has increased, indicating that the new therapies are keeping the less ill infants off ECMO. The major cause of non-survival in this population remains intraventricular hemorrhage. The primary risk factors related to this are thought to be pre-ECMO events, such as hypoxia and/or ischemia either prenatally or post-delivery. ECMO events that may complicate this are heparinization that is required while on ECMO and concern for the effect of shear stress and blood flow pattern changes created by the ECMO pump with venoarterial ECMO, although these changes are not seen in venovenous ECMO, the more common form of ECMO. Newer low-resistant microporous artificial lungs and miniaturized pumping systems may allow ECMO to be performed using less blood and safer equipment. The smaller low-resistant artificial lungs provide the ability to consider giving extracorporeal life support using only this membrane with flow provided by an arterial–venous shunt, thus eliminating the pumping system all together. Trials are ongoing in adults and, if effective, may direct further research into using this technique in newborns where the umbilical artery and vein could be used as the arterial–venous shunt.