Pediatric extracorporeal membrane oxygenation: Current perspectives and outcomes

Extracorporeal membrane oxygenation (ECMO) has revolutionized the management of severe cardiopulmonary failure in neonates, children, and adults. Initially developed as an extension of cardiopulmonary bypass, ECMO has evolved with advancements in oxygenators, miniaturized circuits, and dual-lumen venous cannulas, improving survival rates. This article reviews the history, indications, circuit components, management strategies, and outcomes of pediatric ECMO. The Extracorporeal Life Support Organization registry data highlight a steady increase in pediatric ECMO use, with survival rates improving to 50%–72% based on etiology. Veno-arterial ECMO is commonly used for cardiac failure and extracorporeal cardiopulmonary resuscitation (E-CPR), whereas veno-venous ECMO is preferred for isolated respiratory failure. Despite its benefits, ECMO carries risks such as bleeding, thrombosis, infection, and neurological sequelae, necessitating meticulous anticoagulation management. Recent advances in anticoagulation strategies, left heart decompression techniques, and sedation protocols have enhanced patient outcomes. The growing role of E-CPR in pediatric cardiac arrests underscores ECMOs life-saving potential. However, long-term neurodevelopmental outcomes remain an area of ongoing research. This review provides a comprehensive perspective on ECMO’s current applications, challenges, and future directions in pediatric critical care.