Research Topic

Extra-Corporeal Membrane Oxygenation in pediatric cardiac patients

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Extra-Corporeal Membrane Oxygenation (ECMO) is the circulatory assist system most frequently used in pediatric patients.

The use of ECMO to provide support for circulatory failure has been introduced in clinical practice as a consequence of the success obtained in the 1970s ...

Extra-Corporeal Membrane Oxygenation (ECMO) is the circulatory assist system most frequently used in pediatric patients.

The use of ECMO to provide support for circulatory failure has been introduced in clinical practice as a consequence of the success obtained in the 1970s with ECMO for pediatric patients requiring treatment due to respiratory failure.

At the beginning, ECMO was used as resuscitation after cardiac arrest in pediatric patients, and then as peri-operative stabilization for palliative and corrective procedure in pediatric populations with congenital heart defects.

The Registry of the Extracorporeal Life Support Organization (ELSO) reported more than 10,000 cases of neonatal and pediatric cardiac failure, with 62% survival to separate from ECMO and 43% survival to discharge from hospital.

Despite the recent advances in Ventricular Assist Device (VAD) technology, ECMO remains the most commonly used system of circulatory assistance in pediatric cardiac patients.

The advantages of ECMO include its familiarity among the caregivers involved with the management of pediatric patients with complex congenital heart defects, the capability of providing cardiac (bi-ventricular) and respiratory support, the availability across all pediatric age and body weight groups and the relatively low costs. Furthermore ECMO has ideal indication in pediatric patients with a combination of cardiac and respiratory failure, frequently occurring after repair of complex congenital heart defects and in the case of rapid deployment during a cardio-circulatory arrest.

The disadvantages include the need of a dedicated team of specialists, intensive care monitoring and the risk of major potential complications such as bleeding, thrombosis, infections and multi-organ failure.

This Research Topic aims to attract the experience available on general and specific ECMO fields, such as:
-The feasibility and indication for ECMO in patients with chromosomal abnormalities;
-The ethical issues;
-The resources utilization, the progress obtained with the transport of neonates and children with mobile ECMO;
-The techniques for rapid ECMO deployment;
-The peri-operative management of patients with “functionally” univentricular hearts;
-The preparation and learning curve of a team of ECMO specialists; and
-The experimental research on ECMO.

The experience currently available and the principles applied to support the failing circulation in pediatric cardiac patients with ECMO will constitute the foundation to improve the current techniques and to develop innovative circulatory supports for the future.


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