Extracorporeal membrane oxygenation (ECMO) is widely used for circulatory support in pediatric cardiac patients with
low cardiac output and
hypoxemia. We retrospectively evaluated the efficacy of ECMO support for respiratory and
heart failure in infants and children. From April 2002 to February 2011, 14 patients aged 19 days to 20 years old (average 44 months), with
body weight 2.6 kg to 71 kg (median 14.1 kg), underwent ECMO support for failing cardiac function,
hypoxemia, and
low cardiac output syndrome. In 12 patients, ECMO was introduced after operation for
congenital heart disease (four with complete repair including
Fontan circulation, and eight with palliative repair). In one patient, ECMO was introduced after partial pulmonary resection for
congenital cystic adenomatoid malformation because of
respiratory failure. ECMO was introduced in a patient with severe
heart failure caused by fulminant
myocarditis. Patients' demographics, duration of
extracorporeal membrane oxygenation, additional support, and outcomes were analyzed. Ten patients (71%) were successfully weaned from ECMO, and eight patients (57%) were discharged from the hospital. The mean duration of ECMO support was 332 h (range 11-2030 h). Although management of the ECMO circuit, including anticoagulation (activated clotting time: 150-250), was conducted following the institutional practice guidelines, it was difficult to control the
bleeding. Seven patients required
renal replacement therapy during ECMO support using
peritoneal dialysis or continuous
hemodiafiltration. Five patients had additional operative procedures: systemic-pulmonary shunt in two, bidirectional Glenn takedown with right
modified Blalock-Taussig shunt, total cavopulmonary connection takedown, and redo ECMO in one patient each. The patient who had the longest ECMO support for
respiratory failure due to
acute respiratory distress syndrome after lung surgery was successfully weaned from ECMO because high-frequency oscillation (HFO) improved respiratory function. ECMO for heart and
respiratory failure in infants and children is effective and allows time for recovery of cardiac dysfunction and acute hypoxic insult. The long-term ECMO support for over 2000 h was very rare, but it was possible to wean this patient from ECMO using HFO.