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Background Neurologic complications are common, and amongst the most devastating complications in pediatric patients undergoing extracorporeal life support (ECLS). Carotid artery cannulation (CAN) has been associated with an increase in these complications, thereby shaping practices to avoid this approach in most pediatric patients in which other cannulation approaches are viable. Methods A retrospective review of children (0–18 years) in the ELSO database was undertaken from 1989 through 2013. Multivariate logistic regression analysis of rates of stroke and other neurologic complications based on cannulation technique was undertaken, adjusting for patient factors including age, underlying disease process, and severity of illness. Results A total of 30,282 ECLS runs were found in the database. CAN was associated with higher rates of stroke (5.15% vs 3.74%) and overall neurologic complications. However, when correcting for patient factors, including age, underlying disease process, and support type, CAN was not associated with an increased rate of neurologic complications or stroke (p > 0.05 for both). Conclusion When correcting for patient related factors CAN is not associated with an increase in stroke or neurologic compilcations. CAN should be re-examined as a cannulation technique for older pediatric patients. Level of evidence III. [ABSTRACT FROM AUTHOR]

Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (RCS) is increasingly used in adult patients, but age represents a controversial factor in this setting. Methods Data from the Extracorporeal Life Support Organization registry was analyzed to assess in-hospital survival of elderly patients (≥70 years of age) undergoing VA-ECMO for RCS from 1992 to 2015. In-hospital survival and complications for elderly patients were compared with data in younger adults (≥18 to <70 years of age) supported with VA-ECMO during the same time period for similar indications. Results The mean age of the patient cohort (n = 5,408) was 53.0 ± 15.7 years (range, 18 to 91 years). The elderly group included 735 patients (13.6%), with a mean age of 75.2 ± 4.4 years. In the elderly group, pre-ECMO cardiac procedures were performed in 134 cases (18.9%), and 2.2% received VA-ECMO for postcardiotomy support compared with 0.7% in the younger cohort. The mean duration of VA-ECMO in the elderly group was 101 ± 91 h compared with 138 ± 146 h in the younger group ( p < 0.001). Overall, survival to hospital discharge for the entire adult cohort was 41.4% (2,240 of 5,408), with 30.5% (224 of 735) in the elderly patient group and 43.1% (2,016 of 4,673) in the younger patient group ( p < 0.001). Elderly patients had a higher rate of multiorgan failure. At multivariable analysis age represented an independent negative predictor of in-hospital survival. Conclusions Based on the acceptable survival to hospital discharge in our study, older age alone should not represent an absolute contraindication when considering VA-ECMO support for RCS. [ABSTRACT FROM AUTHOR]

Objective Support with extracorporeal membrane oxygenation for cardiopulmonary failure is done so with venoarterial cannulation in the majority of children with single-ventricle anatomy. However, there is a growing experience for patients with pure oxygenation/ventilation impairment supported with venovenous extracorporeal membrane oxygenation. We describe that experience. Methods Data were collected from the Extracorporeal Life Support Organization registry for patients with single-ventricle anatomy supported with venovenous extracorporeal membrane oxygenation from 1990 to 2012. Descriptive statistics and multivariate analyses for associations with mortality were conducted. Results A total of 89 patients with single-ventricle anatomy had venovenous extracorporeal membrane oxygenation performed at a median age of 66 days (8-221). Survival to discharge was 48%. Fifty-four patients (61%) had shunt physiology, 22 patients (25%) had cavopulmonary connections, and 13 patients (14%) had single-ventricle anatomy but with no previous cardiac surgery. Indication for extracorporeal membrane oxygenation was respiratory failure in 59 patients (63%) and cardiac failure in 30 patients (32%). Double-lumen cannulas were used in 62 patients (70%). Bivariate analysis demonstrated that the duration of intubation before extracorporeal membrane oxygenation, mean airway pressure before cannulation, partial pressure carbon dioxide before cannulation, peak inspiratory pressure before cannulation, pump flow at 24 hours, extracorporeal membrane oxygenation run duration, and presence of renal injury were associated with mortality. Multivariate logistic analysis demonstrated that the duration of intubation (adjusted odds ratio, 1.01; 95% confidence interval, 1.003-1.016; P = .003), partial pressure carbon dioxide (adjusted odds ratio, 1.04; 95% confidence interval, 1.01-1.068; P = .007), mean airway pressure (adjusted odds ratio, 1.16; 95% confidence interval, 1.0-1.342; P = .05), and renal injury (adjusted odds ratio, 6.6; 95% confidence interval, 1.879-23.2; P = .003) were associated with mortality. Conclusions Patients with single-ventricle anatomy in respiratory failure may be treated successfully with venovenous extracorporeal membrane oxygenation, with survival comparable to those treated with venoarterial extracorporeal membrane oxygenation for cardiac failure. Future research on indications for venovenous extracorporeal membrane oxygenation may aid clinicians in deciding the optimal approach for this challenging cohort. [ABSTRACT FROM AUTHOR]

Objective: To examine the outcomes of prolonged (≥14 days) extracorporeal membrane oxygenation (P-ECMO) for adult severe respiratory failure and to assess characteristics associated with survival. Background: The use of ECMO for treatment of severe respiratory adult patients is associated with overall survival rates of 50% to 70% with median ECMO duration of 10 days. No prior multi-institutional studies have examined outcomes of P-ECMO for severe respiratory failure. Methods: Data on all adult (≥18 years) patients who required P-ECMO for severe respiratory failure from 1989 to 2013 were extracted from the Extracorporeal Life Support Organization international multi-institutional registry. We examined outcomes over 23 years and compared the 2 more recent time periods of 1989 to 2006 versus 2007 to 2013. Results: Up to 974 patients, mean age 40.2 (18-83) years, had ECMO duration of mean 25.2 days/median 21.0 days (range: 14-208 days). Venovenous ECMO support was most common (venovenous: 79.5%, venoarterial: 9.9%). Reason for ECMO discontinuation included native lung recovery (54%), organ failure (23.7%), family request (6.7%), hemorrhage (2.7%), and diagnosis incompatible with life (5.6%). Forty patients (4.1%) underwent lung transplant with 50% postoperative in-hospital mortality. Increased prevalence of P-ECMO was noted with 72% (701/974) of all cases reported since 2008. Survival to hospital discharge was 45.4% (443/974) and did not vary with ECMO duration. Multivariate logistic regression analysis confirmed that PECMO patients 2007 to 2013 had a lower risk of death [odds ratio (OR): 0.650; 95% confidence interval (CI), 0.454-0.929; P = 0.010] compared with 1989 to 2006. Factors independently associated with survival were younger age (OR: 0.983; 95% CI, 0.974-0.993; P<0.001) and lower PaCO2 (OR, 0.991; 95% CI, 0.986-0.996; P<0.001). Conclusions: Prolonged ECMO use for adult respiratory failure was associated with a lower (45.4%) hospital survival rate, compared with prior reported survival rates of short duration ECMO. Prolonged ECMO survival significantly increased in recent years, and increasing ECMO duration did not alter the survival fraction in the 1989 to 2013 study cohort. Although P-ECMO survival rates are less than short ECMO runs, P-ECMO support is justified. [ABSTRACT FROM AUTHOR]

Objectives To describe the use of extracorporeal membrane oxygenation (ECMO) in patients with trisomy 21 (T21), to identify risk factors for hospital mortality, and to compare outcomes with those of patients without T21. Study design Children under age 18 years registered in the Extracorporeal Life Support Organization Registry were included. Comparisons between patients with T21 and patients without T21 were performed using the χ 2 or Wilcoxon rank-sum test and multivariable logistic regression. Results The study cohort included 623 patients with T21 and 46 239 patients without T21. The prevalence of T21 was 13.5/1000 patients receiving ECMO. ECMO utilization in patients with T21 increased over time, with 60% of cases occurring in the last decade. There was no significant difference in survival between patients without T21 and those with T21 (63% vs 57%; P = .23). In patients with T21, independent risk factors for mortality before cannulation were a cardiac indication for ECMO support and milrinone use ( P ≤ .001 for both). Multivariable risk factors for mortality on ECMO included hemorrhagic, neurologic, renal, and pulmonary complications ( P < .04 for all). Conclusion The use of ECMO in patients with T21 has increased over time. Patients with a cardiac indication for ECMO have higher mortality compared with those supported for respiratory indications. Despite differences in indications for ECMO, patients with T21 have similar hospital survival as those without T21; thus, by itself, a diagnosis of T21 should not be considered a risk factor for in-hospital mortality when contemplating ECMO cannulation. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study is to evaluate outcomes associated with single site dual-lumen venovenous cannulas (VVDL) and to compare them to those associated with multisite VV ECMO (VVMS) cannulation. Methods The Extracorporeal Life Support (ELSO) Registry was reviewed to identify all children 31 days to 18 years treated with venovenous ECMO from 1998 to 2011 using either VVDL or VVMS techniques. Patient demographics, cannula type, ECMO variables, complications, and patient survival were analyzed. Results From 1998 to 2011, 1323 children underwent venovenous ECMO. The annual utilization of VVDL cannulas has increased and recently surpassed VVMS. Fifty-four percent (n = 717) of patients had VVDL cannulation. This group was significantly younger and weighed less than the VVMS group. VVDL cannulas demonstrated improved weight-adjusted flow performance than traditional cannulation. Overall survival was comparable, 64.4% and 68.6%, for VVMS and VVDL respectively. VVDL cannulas experienced higher mechanical (26.2% vs. 22.5%; p = 0.004) and cardiovascular complications rates (24.4% vs. 21.7%; p = 0.03) than VVMS cannulas, but when stratified by VVDL cannula type, there were no differences between wire-reinforced and non-wire reinforced cannulas. Conclusions VVDL cannulation has become the preferred modality for ECMO therapy in children with respiratory failure and it is mainly utilized in younger patients. The use of newer VVDL cannulas may provide improved pump flow performance without substantial additional risk. [ABSTRACT FROM AUTHOR]

Abstract: The Extracorporeal Life Support Organization Registry has collected outcome data of almost 56,000 patients receiving extracorporeal life support (ECLS) over the last 24 years. The use of neonatal respiratory ECLS declined from a peak of 1516 cases in 1992 to 750–865 cases from 2008 to 2012. The 26,583 cases of neonatal respiratory ECLS (75% survival) represent the largest patient population in the registry. Indicating the rapid growth in other patient populations, 2013 marks the first year where the number of neonatal respiratory ECLS cases is less than 50% of the registry. Stagnant at ~200 cases/year from 1993 to 2004, growth is occurring in the use of pediatric respiratory ECLS with 331–448 cases/year from 2008 to 2012 (58% survival). Similarly, adult respiratory ECLS use increases have been seen from ~100 cases/year from 1996 to 2007 to 480–846 cases/year from 2009 to 2012 (58% survival). Just over 15,000 cardiac ECLS patients have survival rates of 40%, 49%, and 40% for neonates, pediatric, and adults, respectively. [Copyright &y& Elsevier]

There has been an increasing use of ECMO as bridge to heart transplant (OHT) or left ventricular assist device (LVAD) over the last decade. Using data from the Extracorporeal Life Support Organization (ELSO) Registry between 2010 and 2019, we sought to describe the demographics, comorbidities, hemodynamics and ECMO-related information for patients bridged with ECMO to OHT or LVAD. We compared in-hospital mortality and length of stay between these groups, identified predictors of undergoing OHT vs LVAD, and then predictors of in-hospital mortality. 167 patients underwent LVAD implantation vs. 234 patients who underwent OHT. The mean age was 47.8 ± 14.1 years, mean weight was 82.8 ± 21.9 kgs, 29.2% were women and 56.4% were White. The overall use of ECMO as bridge to either therapy has increased from 1.7% in 2010 to 22.2% in 2019 (p<0.001). In-hospital mortality was similar between groups (LVAD: 28.7% vs OHT: 29.1%, p=0.24) while LOS was longer for OHT (LVAD: 49.6 d vs. OHT: 59.5d, p=0.05). Factors associated with LVAD use included weight (OR=0.98, CI 0.97-0.99; p=0.007), cardiogenic shock presentation (OR=0.40, CI 0.21-0.78; p=0.007), hx of LVAD (OR=0.005, CI 0.0001-0.22; p=0.047), respiratory failure (OR=0.28, CI 0.11-0.70; p=0.007), whereas those for OHT included prior transplant (OR=31.26, CI 3.84-780.5; p=0.007), use of a temporary pacemaker (OR=6.5, CI 1.39-50.15; p=0.033) and increased use of inotropes on ECMO (OR=3.77, CI 1.39-11.07; p=0.011). Older age (OR=1.07, p=0.003), cannulation bleeding (OR=26.1, p=0.0009) and surgical bleeding (OR=6.7, p=0.027) in patients who received LVAD and respiratory failure (OR=5, p=0.031) and CRRT (OR=3.82, p=0.017) in patients who received OHT were associated with increased mortality. ECMO use as bridge to advanced therapies has increased over time, with more patients undergoing LVAD than OHT. Mortality was equal between the two groups while length of stay was longer for OHT. [ABSTRACT FROM AUTHOR]

Objective: To report the outcomes from a large multicenter cohort of neonates requiring extracorporeal membrane oxygenation (ECMO) after stage 1 palliation for hypoplastic left heart syndrome. Methods: Using data from the Extracorporeal Life Support Organization (2000–2009), we computed the survival to hospital discharge for neonates (age ≤30 days) supported with ECMO after stage 1 palliation for hypoplastic left heart syndrome. The factors associated with mortality were evaluated using multivariate logistic regression analysis. Results: Among 738 neonates, the survival rate was 31%. The median age at cannulation was 7 days (interquartile range, 4–11). Black race (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2–3.6), mechanical ventilation before ECMO (>15–131 hours: OR, 1.6; 95% CI, 1.1–2.4; >131 hours: OR, 1.9; 95% CI, 1.3–2.9), use of positive end expiratory pressure (>6–8 cm H2O: OR, 1.7; 95% CI, 1.1–2.7; >8 cm H2O: OR, 1.9; 95% CI, 1.2–3.1), and longer ECMO duration (per day, OR, 1.2; 95% CI, 1.1–1.3) increased mortality. ECMO support for failure to wean from cardiopulmonary bypass (OR, 1.6; 95% CI, 1.02–2.4) also decreased survival. ECMO complications, including renal failure (OR, 1.9; 95% CI, 1.2–3.1), inotrope requirement (OR, 1.5; 95% CI, 1.1–2.1), myocardial stun (OR, 3.2; 95% CI, 1.3–7.7), metabolic acidosis (OR, 2.9; 95% CI, 1.3–6.7), and neurologic injury (OR, 1.7; 95% CI, 1.1–2.6), during support also increased mortality. Conclusions: Mortality for neonates with hypoplastic left heart syndrome supported with ECMO after stage 1 palliation is high. Longer ventilation before cannulation, longer support duration, and ECMO complications increased mortality. [Copyright &y& Elsevier]

Background: Advances in centrifugal blood pump technology have led to increased use of centrifugal pumps in extracorporeal membrane oxygenation (ECMO) circuits. Their efficacy and safety in critically ill neonates remains unknown. Blood cell trauma leading to hemolysis may result in end-organ injury in critically ill neonates receiving centrifugal pump ECMO. We hypothesized that neonates undergoing ECMO support using centrifugal pumps were at increased odds of hemolysis and subsequent end-organ injury. Methods: Children 30 days of age or younger who received support with venoarterial ECMO and were reported to the Extracorporeal Life Support Registry during 2007 to 2009 underwent propensity score matching (Greedy matching 1:1) using pre-ECMO support characteristics. Results: A total of 1,592 neonates receiving ECMO (centrifugal pump = 163 and roller pump = 1,492) were identified. Significant differences in demographic, presupport, and cannulation variables were present before matching. One hundred seventy-six neonates who were supported using either centrifugal (n = 88) or roller pumps (n = 88) were matched using propensity scoring. No significant differences in demographic, presupport, or cannulation variables were present after matching. Neonates undergoing support using centrifugal pumps had increased odds of hemolysis (odds ratio [OR], 7.7 [2.8–21.2]), hyperbilirubinemia (OR, 20.8 [2.7–160.4]), hypertension (OR, 3.2 [1.3–8.0]), and acute renal failure (OR, 2.4 [1.1–5.6]). Survival to discharge was not different between pump types. Conclusions: Use of ECMO using centrifugal pumps is associated with increased odds of hemolysis that likely contributes to other end-organ injury. Research into the optimal use of centrifugal pumps and strategies to prevent support-related complications need to be investigated. [ABSTRACT FROM AUTHOR]

Objective: Extracorporeal membrane oxygenation has been used to support children with cardiac failure after the Fontan operation. Mortality is high, and causes of mortality remain unclear. We evaluated the in-hospital mortality and factors associated with mortality in these patients. Methods: Extracorporeal Life Support Organization registry data on patients requiring extracorporeal membrane oxygenation after the Fontan operation from 1987 to 2009 were retrospectively analyzed. Demographics and extracorporeal membrane oxygenation data were compared for survivors and nonsurvivors. A multivariable logistic regression model was used to identify factors associated with mortality. Results: Of 230 patients, 81 (35%) survived to hospital discharge. Cardiopulmonary resuscitation was more frequent (34% vs 17%, P = .04), and median fraction of inspired oxygen concentration was higher (1 [confidence interval, 0.9–1.0] vs 0.9 [confidence interval, 0.8–1.0], P = .03) before extracorporeal membrane oxygenation in nonsurvivors compared with survivors. Extracorporeal membrane oxygenation duration and incidence of complications, including surgical bleeding, neurologic injury, renal failure, inotrope use on extracorporeal membrane oxygenation, and bloodstream infection, were higher in nonsurvivors compared with survivors (P < .05 for all). In a multivariable model, neurologic injury (odds ratio, 5.18; 95% confidence interval, 1.97–13.61), surgical bleeding (odds ratio, 2.36; 95% confidence interval, 1.22–4.56), and renal failure (odds ratio, 2.81; 95% confidence interval, 1.41–5.59) increased mortality. Extracorporeal membrane oxygenation duration of more than 65 hours to 119 hours (odds ratio, 0.33; 95% confidence interval, 0.14–0.76) was associated with decreased mortality. Conclusions: Cardiac failure requiring extracorporeal membrane oxygenation after the Fontan operation is associated with high mortality. Complications during extracorporeal membrane oxygenation support increase mortality odds. Prompt correction of surgical bleeding when possible may improve survival. [Copyright &y& Elsevier]

Abstract: Purpose: Venoarterial extracorporeal membrane oxygenation (ECMO) (VA) is used more commonly in neonates with congenital diaphragmatic hernia (CDH) than venovenous ECMO (VV). We hypothesized that VV may result in comparable outcomes in infants with CDH requiring ECMO. Methods: We retrospectively analyzed the Extracorporeal Life Support Organization (ELSO) database (1991-2006). Multivariate logistic regression analyses were used to compare VV- and VA-associated mortality. Results: Four thousand one hundred fifteen neonates required ECMO, with an overall mortality rate of 49.6%. Venoarterial ECMO was used in 82% and VV in 18% of neonates. Pre-ECMO inotrope use and complications were equivalent between VA and VV. The mortality rate for VA and VV was 50% and 46%, respectively. After adjusting for birth weight, gestational age, prenatal diagnosis, ethnicity, Apgar scores, pH less than 7.20, Paco 2 greater than 50, requiring high-frequency ventilation, and year of ECMO, there was no difference in mortality between VV vs VA. Renal complications and on-ECMO inotrope use were more common with VV, whereas neurologic complications were more common with VA. The conversion rate from VV to VA was 18%; conversion was associated with a 56% mortality rate. Conclusion: The short-term outcomes of VV and VA are comparable. Patients with CDH who fail VV may be predisposed to a worse outcome. Nevertheless, VV offers equal benefit to patients with CDH requiring ECMO while preserving the native carotid. [Copyright &y& Elsevier]

Background: Extracorporeal membrane oxygenation (ECMO) to support cardiopulmonary resuscitation (CPR) has been shown to improve survival in children and adults. We describe outcomes after the use of ECMO to support CPR (E-CPR) in adults using multiinstitutional data from the Extracorporeal Life Support Organization (ELSO) registry. Methods: Patients greater than 18 years of age using ECMO to support CPR (E-CPR) during 1992 to 2007 were extracted from the ELSO registry and analyzed. Results: Two hundred and ninety-seven (11% of 2,633 adult ECMO uses) reports of E-CPR use in 295 patients were analyzed. Median age was 52 years (interquartile range [IQR], 35, 64) and most patients had cardiac disease (n = 221; 75%). Survival to hospital discharge was 27%. Brain death occurred in 61 (28%) of nonsurvivors. In a multivariate logistic regression model, pre-ECMO factors including a diagnosis of acute myocarditis (odds ratio [OR]: 0.18; 95% confidence interval [CI]: 0.05 to 0.69) compared with noncardiac diagnoses and use of percutaneous cannulation technique (OR: 0.42; 95% CI: 0.21 to 0.87) lowered odds of mortality, whereas a lower pre-ECMO arterial blood partial pressure of oxygen (Pa o 2 ) less than 70 mm Hg (OR: 2.7; 95% CI: 1.21 to 6.07) compared with a Pa o 2 of 149 mm Hg or greater increased odds of mortality. The need for renal replacement therapy during ECMO increased odds of mortality (OR: 2.41; 95% CI: 1.34 to 4.34). Conclusions: The use of E-CPR was associated with survival in 27% of adults with cardiac arrest facing imminent mortality. Further studies are warranted to evaluate and better define patients who may benefit from E-CPR. [Copyright &y& Elsevier]

Supplemental Digital Content is available in the text. Background: There has been increasing use of extracorporeal membrane oxygenation (ECMO) as bridge to heart transplant (orthotopic heart transplant [OHT]) or left ventricular assist device (LVAD) over the last decade. We aimed to provide insights on the population, outcomes, and predictors for the selection of each therapy. Methods: Using the Extracorporeal Life Support Organization Registry between 2010 and 2019, we compared in-hospital mortality and length of stay, predictors of OHT versus LVAD, and predictors of in-hospital mortality for patients with cardiogenic shock that were bridged with ECMO to OHT or LVAD. One hundred sixty-seven patients underwent LVAD versus 234 patients who underwent OHT. Results: The overall use of ECMO has increased from 1.7% in 2010 to 22.2% in 2019. Mortality was similar between groups (LVAD: 28.7% versus OHT: 29.1%) while length of stay was longer for OHT (LVAD: 49.6 versus OHT: 59.5 days, P =0.05). Factors associated with OHT included prior transplant (odds ratio [OR]=31.26 [CI, 3.84–780.5]), use of a temporary pacemaker (OR=6.5 [CI, 1.39–50.15]), and increased use of inotropes on ECMO (OR=3.77 [CI, 1.39–11.07]), whereas LVAD use was associated with weight (OR=0.98 [CI, 0.97–0.99]), cardiogenic shock presentation (OR=0.40 [CI, 0.21–0.78]), previous LVAD (OR=0.01 [CI, 0.0001–0.22]), respiratory failure (OR=0.28 [CI, 0.11–0.70]), and milrinone infusion (OR=0.32 [CI, 0.15–0.67]). Older age (OR=1.07 [CI, 1.02–1.12]), cannulation bleeding (OR=26.1 [CI, 4.32–221.3]), and surgical bleeding (OR=6.7 [CI, 1.26–39.9]) in patients receiving LVAD and respiratory failure (OR=5 [CI, 1.17–23.1]) and continuous renal replacement therapy (OR=3.82 [CI, 1.28–11.9]) in patients receiving OHT were associated with increased mortality. Conclusions: ECMO use as a bridge to advanced therapies has increased over time, with more patients undergoing LVAD than OHT. Mortality was equal between the 2 groups while length of stay was longer for OHT. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Extracorporeal membrane oxygenation (ECMO) is a means of respiratory and hemodynamic support for patients failing conventional therapies. Children requiring hematopoietic stem cell transplantation who develop complications during therapy may require ECMO. Such patients pose medical and ethical challenges for clinicians considering initiation of ECMO. The authors review the outcomes of these patients and propose recommendations. Methods: The Extracorporeal Life Support Organization Registry was queried for all patients younger than 18 years with an International Classification of Diseases, Ninth Revision, or Current Procedural Terminology code related to bone or stem cell transplant. Results: Nineteen children in the registry met inclusion criteria. The median age was 9.6 years (7 months to 17.5 years). Initiation of ECMO was for pulmonary support (n = 17), cardiac support (n = 1), or cardiopulmonary resuscitation (n = 1). The median duration of ECMO support was 5.1 days (range, 30 hours to 42 days). Pulmonary infections included 3 parainfluenza, 2 Pneumocystis carinii, 1 influenza A, and 1 respiratory syncytial virus. Overall, 15 (79%) died during their ECMO run, whereas only 4 (21%) survived to come off ECMO. Furthermore, of those who survived their ECMO run, only one patient survived to discharge from the hospital. Risk factors for death on ECMO include development of renal complications and development of multiorgan dysfunction. Conclusion: Patients who require ECMO for cardiopulmonary support after hematopoietic stem cell transplantation have a poor prognosis. Clinicians must be cautious in presenting this option to parents and present them with appropriate expectations in this high-risk population. [Copyright &y& Elsevier]

Since its beginnings in 1989, the Extracorporeal Life Support Organization (ELSO) Registry has collated and reported data on over 30,000 patients. The majority of patients entered into the Registry have been neonates with respiratory failure from meconium aspiration, persistent pulmonary hypertension, or congenital diaphragmatic hernia. These patients suffer from refractory hypoxemia; thus, this supportive technique came to be called “Extracorporeal Membrane Oxygenation (ECMO)” for its ability to provide excellent gas exchange. With advances in prevention, diagnosis, and treatment measures for neonatal respiratory failure, need for ECMO support has fallen from the peak of 1500 cases in the early 1990s to 800 cases annually. Sixty-six percent (over 19,000) of patients in the Registry are under the category of neonatal respiratory failure, with a 77% overall survival reported to discharge. The success of neonatal ECMO has led to expansion of the field to pediatric, cardiac, and adult patients. An average of 200 pediatric patients receive ECMO for respiratory failure per year with an overall survival of 55%. Adult respiratory failure patients form a smaller group, with less than 100 cases reported to the ELSO registry per year. Survival mirrors that noted in the pediatric ECMO population. The application of ECMO or related techniques continues to increase for cardiac failure across all age groups. Overall survival in cardiac patients ranges from 33% to 43%. A novel form of extracorporeal support is “ECPR” or ECMO during cardiac arrest. Bypass circuits and equipment can be set up and instituted within a very short period of time in this circumstance, thus the name “rapid deployment ECMO” has become associated with this form of support. Overall survival in the near-600 patients placed on ECMO during resuscitation is 40%. [Copyright &y& Elsevier]