Introduction

Extracorporeal membrane oxygenation (ECMO) can provide lifesaving respiratory and cardiac support for patients when maximal conventional therapy is failing. With 45 years of experience since the first successful use of ECMO to support a neonate with respiratory failure, ECMO has been utilized to support neonates, infants, children, and adults with a variety of congenital and acquired respiratory and cardiac diseases. The pathophysiological mechanisms in neonatal versus pediatric respiratory failure are different. Limited alveolar gas exchange versus oxygenation failure due to inadequate pulmonary blood flow with pulmonary hypertension differentiate the common forms of pediatric and neonatal respiratory failure. Meanwhile, neonates, infants, children and adults with congenital and acquired cardiac disease may require mechanical circulatory support secondary to hemodynamic instability due to their critical cardiac lesions. Indications for cardiac ECMO include low cardiac output syndrome (often peri-operative), refractory arrhythmias, cardiogenic shock, septic shock, and cardiopulmonary resuscitation.[1] In these and other settings, ECMO may be used as a treatment option by building a bridge to therapy, bridge to decision, bridge to transplantation (including heart transplantation, lung transplantation, and combined heart and lung transplantation) or bridge to recovery.