An updated guide for clinicians: extracorporeal membrane oxygenation for pediatric patients with refractory acute respiratory failure

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) remains a mainstay for refractory respiratory failure in select pediatric patients. Clinical practice surrounding its use continues to evolve, reflecting advances in technology, management strategies, and patient selection. Ongoing research and innovation are actively shaping VV-ECMO's future directions aimed at optimizing outcomes and increasing understanding of best practices.

Areas covered: This review summarizes the fundamental concepts of VV-ECMO and highlights established practices and ongoing questions with a focus on indications/contraindications, cannulation, ventilator management, anticoagulation, fluid management, and weaning/decannulation. We also examine recent advancements and emerging technologies that are shaping the evolution of pediatric ECMO therapy. Narrative literature review of the PubMed central database was utilized to help inform this review.

Expert opinion: Despite recent progress in pediatric VV-ECMO, substantial gaps remain in understanding optimal practices. And while there are many promising advances, there is a need for high-quality, collaborative research to further define best practices and guide ongoing future improvements for this life-sustaining therapy.

Keywords: ECMO; Pediatric; acute respiratory distress syndrome; anticoagulation; extracorporeal; respiratory failure; venovenous.