Drug therapies in neonates and children during extracorporeal membrane oxygenation (ECMO)

Abstract

Extracorporeal life support (ECLS) or extra corporeal membrane oxygenation (ECMO) is a technique for providing life support in severe but potentially reversible cardiorespiratory failure in patients with an expected mortality greater than 80%. First pioneered in cardiopulmonary bypass during cardiac surgery, ECLS has been used as prolonged cardiopulmonary support in neonates since 1976. It has been shown to have a survival benefit in neonates and adults. Increasingly ECMO support is used in older children and adults. (ELSO registry report 2010) ECMO provides extracorporeal gas exchange and circulatory support by pumping blood from the patient through an artificial circuit comprising of tubing, a pump, an oxygenator and a heater. The oxygenator is used to oxygenate the blood and extract carbon dioxide. Blood is drawn from a venous access site, preferably a central catheter positioned in the right atrium, and returned either in the right atrium via a double lumen catheter (venovenous ECMO) for respiratory support or via the carotid artery (venoarterial ECMO) for cardiopulmonary support.