The purpose of this report is to describe our experience with veno-art
erial (VA) and veno-venous extracorporeal membrane oxygenation (VV-ECM
O) for neonates and children with severe acute respiratory or cardioci
rculatory failure. From 1990 to 1994 20 neonates and 12 children were
treated at the ECMO center in Graz. Indications for ECMO were acute re
spiratory failure in 27 patients and cardiocirculatory failure in 5 pa
tients. Mean duration of ECMO was 228 +/- 30 hours. Fifteen neonates w
ere weaned from ECMO and were subsequently extubated. Of the 12 childr
en 7 had severe acute respiratory failure and underwent VV-ECMO. Five
of these 7 children were weaned from ECMO and subsequently extubated.
Only two of 5 patients with cardiac ECMO support could be weaned from
bypass; one patient subsequent ly died, but the other patient is a lon
g-term survivor. All patients with cardiac ECMO support after open hea
rt surgery had severe mediastinal bleeding. The survival rate in neona
tes and pediatric patients with respiratory failure treated by ECMO wa
s 75% and 71%, respectively, whereas it was only 20% in children with
cardiocirculatory failure. Major complications on ECMO were local and
intracerebral bleeding. ECMO is an effective therapy for neonates and
children with acute respiratory failure. It is less effective for card
iac support in children after open heart surgery, but the use of hepar
in-layered ECMO systems might increase the safety of the procedure.