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Updated: May 1, 2026
Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Extracorporeal membrane oxygenation for pediatric respiratory failure: History, development and current status
Anna Maslach-Hubbard1, Susan L Bratton1
1Anna Maslach-Hubbard, Susan L Bratton, Division of Critical Care Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT 84158, United States.
Insights
Extracorporeal membrane oxygenation (ECMO) provides life support for severe respiratory failure. While technological advances improve ECMO, pediatric survival rates remain stable at 43%, highlighting the need for more research.
Area of Science:
- Cardiovascular and Respiratory System Physiology
- Medical Technology and Engineering
- Pediatric Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital treatment for acute severe respiratory failure unresponsive to conventional therapies.
- While initially used predominantly in neonates, ECMO use is shifting towards older children and adults, with technological advancements enhancing its application.
- Veno-arterial (VA) ECMO is common, but veno-venous (VV) ECMO offers lower risks of neurological injury and mortality.
Purpose of the Study:
- To review the current status and technological advancements in ECMO for acute severe respiratory failure.
- To analyze survival rates and risk factors associated with ECMO use in pediatric patients.
- To identify knowledge gaps in daily patient management during ECMO therapy.
Main Methods:
- Review of recent technological innovations in ECMO circuits, cannulas, pumps, and oxygenators.
- Analysis of pediatric ECMO survival data, considering factors like diagnosis, age, and prior mechanical ventilation.
- Assessment of current medical evidence for daily ECMO patient management.
Main Results:
- Pediatric ECMO survival rates have remained stable at approximately 43% over several decades, despite technological progress.
- Risk factors for mortality include prolonged mechanical ventilation before ECMO, VA mode support, older patient age, and prolonged ECMO duration.
- Significant knowledge deficits exist regarding optimal daily management of ECMO patients, necessitating collaborative research.
Conclusions:
- Successful ECMO implementation before irreversible organ damage is crucial for survival, unless used as a bridge to transplant.
- Further research and data linkage are essential to improve pediatric ECMO patient management and outcomes.
- Technological refinements have improved ECMO capabilities, but survival rates require further investigation and improvement.
Abstract:
Extracorporeal membrane oxygenation (ECMO) is currently used to support patients of all ages with acute severe respiratory failure non-responsive to conventional treatments, and although initial use was almost exclusively in neonates, use for this age group is decreasing while use in older children remains stable (300-500 cases annually) and support for adults is increasing. Recent advances in technology include: refinement of double lumen veno-venous (VV) cannulas to support a large range of patient size, pumps with lower prime volumes, more efficient oxygenators, changes in circuit configuration to decrease turbulent flow and hemolysis. Veno-arterial (VA) mode of support remains the predominant type used; however, VV support has lower risk of central nervous injury and mortality. Key to successful survival is implementation of ECMO before irreversible organ injury develops, unless support with ECMO is used as a bridge to transplant. Among pediatric patients treated with ECMO mortality varies by pulmonary diagnosis, underlying condition, other non-pulmonary organ dysfunction as well as patient age, but has remained relatively unchanged overall (43%) over the past several decades. Additional risk factors associated with death include prolonged use of mechanical ventilation (> 2 wk) prior to ECMO, use of VA ECMO, older patient age, prolonged ECMO support as well as complications during ECMO. Medical evidence regarding daily patient management specifically related to ECMO is scant, it usually mirrors care recommended for similar patients treated without ECMO. Linkage of the Extracorporeal Life Support Organization dataset with other databases and collaborative research networks will be required to address this knowledge deficit as most centers treat only a few pediatric respiratory failure patients each year.
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