Neonatal extra-corporeal life support: indications and limitations

Area of Science:

• Pediatric Cardiology
• Neonatal Intensive Care
• Cardiovascular Surgery

Background:

• Cardiac extra-corporeal life support (ECLS) is increasingly utilized in high-risk neonatal heart surgery.
• Despite advances, survival for neonates requiring ECLS has not improved, remaining below 40% in the last decade.
• ECLS is a complex therapy used for various critical conditions including post-operative low cardiac output syndrome, cardiac arrest, and as a bridge to recovery.

Purpose of the Study:

• To review the current application and outcomes of neonatal cardiac ECLS.
• To highlight the challenges and contexts in which ECLS is applied in neonates.
• To identify the need for further research in patient selection and outcome prediction for neonatal cardiac ECLS.

Main Methods:

• Review of current literature and clinical practices regarding neonatal cardiac ECLS.
• Analysis of contexts including post-operative support, cardiac arrest, high-risk procedures, and bridge to recovery.
• Examination of trends in ECLS use for single ventricle versus biventricular patients.

Main Results:

• ECLS use has increased, particularly for neonates with single ventricle disease, with outcomes comparable to biventricular patients.
• Survival rates for neonates requiring cardiac ECLS remain critically low, below 40%.
• ECLS is applied across a spectrum of critical neonatal cardiac conditions.

Conclusions:

• Neonatal cardiac ECLS is a technically demanding but essential therapy for complex pediatric cardiac surgery.
• Improved patient selection and identification of outcome predictors, including long-term neurological development, are crucial for enhancing survival.
• Further research is imperative to optimize the use and outcomes of ECLS in neonates with complex heart disease.