Extracorporeal membrane oxygenation (ECMO) in pediatric congenital heart disease: a comprehensive review

TL;DR

This paper reviews the use of ECMO in children with congenital heart disease, highlighting its benefits, challenges, and recent advancements.

Contribution

The paper provides a comprehensive review of ECMO's role in pediatric CHD, emphasizing recent developments and future research directions.

Findings

ECMO is used as a bridge to recovery, post-surgery stabilization, and heart transplantation in pediatric CHD.

Newer anticoagulants like bivalirudin and neuroprotective techniques improve outcomes but challenges like bleeding and neurodevelopmental issues remain.

ECMO's high cost and limited access in low-resource areas remain significant barriers.

Abstract

Extracorporeal membrane oxygenation (ECMO), which provides life-saving assistance in severe cardiac and pulmonary failure cases, has emerged as an important technique in managing children with congenital heart disease (CHD).

In this review, we discuss the evolution of ECMO over the years, its clinical uses, and the results in pediatric CHD. ECMO has been utilized as a bridge to recovery, in stabilizing an individual after surgery, and as a bridge to heart transplantation. Cannulation procedures that are adjusted according to the anatomy of an individual have improved outcomes, although bleeding and neurologic concerns remain a matter of concern. In addition, long-term neurodevelopmental disorders and renal failure are also among the alarming outcomes. The use of newer anticoagulant drugs like bivalirudin, which lowers the risk of bleeding, and genomic testing for personalized treatment are examples of recent developments. Furthermore, neuroprotective techniques such as erythropoietin and dexmedetomidine can also enhance the neurocognitive outcomes. Finally, improvements in monitoring systems and pump technology contribute to increased ECMO efficacy and safety.

Despite these developments, ECMO’s expense and restricted accessibility remain major obstacles, especially in areas with low resources. In this review, the advancements in ECMO technology and care are highlighted, and it also emphasizes future research to address the current challenges.

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