Extracorporeal membrane oxygenation as salvage in pediatric surgical emergencies

Extracorporeal membrane oxygenation (ECMO) has become an established therapy for acute neonatal and pediatric respiratory failure. On an institutional level, once an ECMO program is well established, ECMO can be viewed as a logical extension of critical care for multisystem organ failure. The question left unanswered is "Should anyone die without being offered ECMO?" The authors reviewed a 10-year clinical experience with ECMO and its application as salvage therapy in pediatric surgical emergencies. Eight patients with life-threatening multisystem organ failure, from diverse causes, were treated; the survival rate was 50%. All survivors were neurologically intact at the time of discharge. The success of ECMO, coupled with improvements in technique, apparatus, and expertise, has allowed application of ECMO as an invasive extension of intensive care to diverse patient groups. These results have encouraged the authors to expand their indications and to push the "envelope" in offering ECMO to critically ill infants and children with life-threatening organ failure.