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Extracorporeal membrane oxygenation (ECMO) is a highly invasive mechanism of cardiopulmonary support. ECMO is only initiated when all other therapies have failed to reverse severe neonatal respiratory failure. ECMO, a modification of the cardiopulmonary bypass techniques initially developed for cardiac surgery, was first reported in neonatal respiratory failure in 1976. [5] Initially, only moribund patients were treated and

As experience with the technique increased, better selection and exclusion criteria were developed. Though ECMO seemed to be improving survival in these selected neonatal patients, mortality risks of 80% that were

Two prospective, randomized trials were performed [4] [81] that suggested improved survival with ECMO, but both used unusual statistical analyses and adaptive designs that limited the number of

Because of the ethical dilemma of withholding potentially life-saving therapy that had become widely available, it became almost impossible to conduct a prospective randomized trial in

In the United Kingdom, ECMO was not as widely available or enthusiastically embraced initially. Between 1993 and 1995, a randomized, prospective trial of ECMO in neonatal respiratory failure was conducted. This study was terminated early when a clear survival Extracorporeal Membrane Oxygenation, extracorpereal[105]

The mortality rate in the conventional group was 59%, compared with a 30% mortality in the ECMO group. This survival advantage was seen in all

ECMO is a support technique that allows the underlying disease process to be corrected. Selecting patients who are at high risk for mortality, and therefore are likely to benefit from this potentially risky support, is

Cannulation for ECMO is via the right internal jugular vein for veno-venous bypass or the vein and the

The most worrisome complication of Extracorporeal Membrane Oxygenation support is bleeding. Systemic heparinization is required to

Overall survival from the 2002 ELSO registry is 80% but differs according to diagnosis: meconium aspiration, 94%; RDS, 84%; primary pulmonary hypertension, 82%; sepsis, 77%; and diaphragmatic hernia, 58%. [31]

Survival is one measure of success, but sequelae affecting quality of life are important as well. Generally the outcome of a patient relates to the underlying disease. Occasionally, however, because of the lack of a timely referral, the

ECMO is used to support a population of patients with a historically high risk for mortality and has been shown to improve survival. Determination of disease severity and timely referral will help ensure an