Pediatric Extracorporeal Life Support: Extracorporeal Membrane Oxygenation and Mechanical Circulatory Support

Heart failure-related hospitalizations occur in 11, 000-14, 000 children annually in the United States, with an overall mortality of about 7%.1 Despite the number of annual pediatric heart transplants in the United States being stable at about 350 annually (Fig. 6.1) 2 due to a relative shortage of donors and consequent longer waiting times in this age group, 3 an increasing use of mechanical circulatory support (MCS)4 has led to better overall outcomes in this patient group. Extracorporeal membrane oxygenation (ECMO) has been invaluable in achieving superior surgical outcomes for complex congenital cardiac diseases.5, 6 Although reasonable for short-term support for up to a few weeks, historically the survival to transplantation with long-term support with ECMO alone has been as low as 50%.7, 8 Superior results are achieved with long-term ventricular assist devices (VADs).9, 10 The mode of mechanical support is chosen based on the child’s needs, anticipated duration of support, likelihood of native organ recovery, and above all the size of the patient. Broadly speaking, support may be classified into one of the following categories: • Bridge to recovery. Mechanical support is used temporarily until the native cardiac function recovers from the acute pathology, for example with acute myocarditis or temporary myocardial dysfunction postcardiac surgery. Usual modes of support in this situation are either ECMO or temporary short-term VADs.