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Review
. 2021 Jun;180(6):1675-1692.
doi: 10.1007/s00431-020-03898-9. Epub 2021 Feb 5.

Neonatal respiratory and cardiac ECMO in Europe

Ilaria Amodeo  1 , Matteo Di Nardo  2 , Genny Raffaeli  1   3 , Shady Kamel  1   4 , Francesco Macchini  5 , Antonio Amodeo  6 , Fabio Mosca  1   3 , Giacomo Cavallaro  7
Affiliations
Review

Neonatal respiratory and cardiac ECMO in Europe

Ilaria Amodeo et al. Eur J Pediatr. 2021 Jun.

Abstract

Neonatal extracorporeal membrane oxygenation (ECMO) is a life-saving procedure for critically ill neonates suffering from a potentially reversible disease, causing severe cardiac and/or respiratory failure and refractory to maximal conventional management. Since the 1970s, technology, management, and clinical applications of neonatal ECMO have changed. Pulmonary diseases still represent the principal neonatal diagnosis, with an overall 74% survival rate, and up to one-third of cases are due to congenital diaphragmatic hernia. The overall survival rate in cardiac ECMO is lower, with congenital heart defect representing the main indication. This review provides an overview of the available evidence in the field of neonatal ECMO. We will address the changing epidemiology, basic principles, technologic advances in circuitry, and monitoring, and deliver a current multidisciplinary management framework, focusing on ECMO applications, complications, and long-term morbidities. Lastly, areas for further research will be highlighted.Conclusions: ECMO is a life support with a potential impact on long-term patients' outcomes. In the next years, advances in knowledge, technology, and expertise may push neonatal ECMO boundaries towards more premature and increasingly complex infants, with the final aim to reduce the burden of ECMO-related complications and improve overall patients' outcomes. What is Known: • ECMO is a life-saving option in newborns with refractory respiratory and/or cardiac failure. • The multidisciplinary ECMO management is challenging and may expose neonates to complications with an impact on long-term outcomes. What is New: • Advances in technology and biomaterials will improve neonatal ECMO management and, eventually, the long-term outcome of these complex patients. • Experimental models of artificial placenta and womb technology are under investigation and may provide clinical translation and future research opportunities.

Keywords: Anticoagulation; Cardiac ECMO; Developmental Hemostasis; ECMO; ECMO complications; ECMO management; Follow-up; Neonate; Respiratory ECMO.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Veno-Arterial (VA) ECMO with passive hemofiltration (A); Veno-Venous (VV) ECMO with dual lumen (DL) single bicaval cannula and passive hemofiltration (B); DL bicaval cannula (C)
Fig. 2
Fig. 2
Overview of the critical points of ECMO management
Fig. 3
Fig. 3
Complications during neonatal respiratory and cardiac ECMO and incidence
See this image and copyright information in PMC

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