The present state of ECMO for newborn infants and children

Venoarterial extracorporeal membrane oxygenation (V-A ECMO) is considered to provide not only lung support but also cardiac assist to acute cardiac or pulmonary failure of the newborn infants and children. However, an excessive "LUNG REST" strategy may lead to myocardial hypoxic damage in patients without PDA or any left-to-right cardiac shunt. The estimation of pulmonary vascular resistance and cardiac contractility, which is independent of preload, afterload and heart rate, is very important for the selection of ECMO, vascular access and weaning strategy from ECMO. Introduction of new ECMO techniques including heparin-coated or FUT-175 infused circuit, ECMO into double-lumen venous cannulas, the other therapies, such as artificial surfactant therapy, high frequency oscillation or inhaled nitric oxide can affect our approaches toward patients with severe cardiorespiratory failure.