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 recently 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 Europe extracorporeal CO(2) removal (ECCO(2)R) in adults has been more successful. 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 positive end-expiratory pressures of over 6 cm H(2)O for more than 12 h after being treated for more than 48 h should be considered candidates, given the high mortality of children with ARDS (70%). Survival averages 50% to 60%. Circuits and patient management techniques are very similar to those for newborn ECMO, but patients usually require longer times on ECMO. There are many more options for cannulation for both venoarterial 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 determine which patients can benefit from ECMO as well as the exact application in each case.