Abstract
Although the exact timing and criteria for use of extracorporeal membrane oxygenation (ECMO) are still debated, ECMO has become a widely accepted therapeutic option for neonates with respiratory failure in whom conventional support has failed. ECMO also is used in older children with respiratory failure and in patients with cardiac dysfunction or cardiac arrest. In addition, ECMO has been successfully applied in patients who were previously excluded from receiving it, such as patients with trauma, burns, sickle cell disease, cancer, or HIV infection. The challenge in patient selection is to determine which patients are at high risk for death and whether they have a reversible pathology. Contraindications to ECMO include prolonged mechanical ventilation, multiple organ failure, and neurologic damage or underlying diseases that have a poor prognosis. Most infants can be successfully weaned from ECMO support in a few days; however, a longer duration of support usually is needed for older patients.