EXTRACORPOREAL MEMBRANE-OXYGENATION (ECMO) FOR PULMONARY PARENCHYMAL DISEASE IN OLDER CHILDREN

Extracorporeal membrane oxygenation (ECMO) for the support of children outside the newborn period who have pulmonary failure is only recentl y becoming accepted. It is again being applied, after earlier failures , because well-trained teams and improved equipment and techniques are available following the success of neonatal ECMO. In addition, in Eur ope extracorporeal CO2 removal (ECCO2R) in adults has been more succes sful. The use of ECMO for pulmonary failure in children does not have fixed indications and has had considerably less success than neonatal ECMO. Patients who require inspired oxygen fractions of over 0.5 and p ositive end-expiratory pressures of over 6 cm H2O for more than 12 h a fter being treated for more than 48 h should be considered candidates, given the high mortality of children with ARDS (70%). Survival averag es 50% to 60%. Circuits and patient management techniques are very sim ilar to those for newborn ECMO, but patients usually require longer ti mes on ECMO. There are many more options for cannulation for both veno arterial and venovenous techniques than in neonatal and cardiac ECMO. The improving results indicate that ECMO will play a part in treating children with pulmonary failure. Further studies will be required to d etermine which patients can benefit from ECMO as well as the exact app lication in each case.