Current status of pediatric/neonatal extracorporeal life support: clinical outcomes, circuit evolution, and translational research

Abstract

Extracorporeal life support (ECLS) offers lifesaving mechanical circulatory support for patients afflicted with respiratory and/or cardiac failure. Neonatal respiratory patients have higher survival rates compared to pediatric patients, while, for cardiac cases, pediatric patients are more likely to survive. The indications for ECLS have been expanded due to the improved technology and favorable outcomes. However, the rate of mortality and morbidity for ECLS patients remains significant. Mechanical complications still comprise a large percentage of ECLS complications, leaving definite room for improvement in ECLS circuit technology in the future. As a pre-clinical evaluating tool, translational research will provide more useful information for the selection of ECLS devices, encourage further development of ECLS technology, and, ultimately, benefit the patients.

In Vitro Hemodynamic Evaluation of a Novel Pulsatile Extracorporeal Life Support System: Impact of Perfusion Modes and Circuit Components on Energy Loss

“…Currently, the most commonly used blood pump for the ECLS system is the centrifugal pump (11). The centrifugal pump has a number of advantages over the roller pump, including small size, low priming volume, easy maintenance, durability, and safety.…”

First In Vivo Results of a Novel Pediatric Oxygenator with an Integrated Pulsatile Pump

“…[7][8][9] Compared with neonatal patients less ECMO treatment is performed on pediatric patients with pulmonary failure, whereas it provides support for cardiac failure arising from anatomic abnormalities of the heart or cardiogenic shock. 10 Here, the survival rates are less than 50%. 5 In general, pediatric patients are very sensitive, and particular attention has to be paid to their small size and their hemostasiological differences compared with adult patients.…”

A Multidisciplinary Approach to Expand the Use of Pediatric ECLS Systems in Turkey

“…The information is updated and shared with regular symposiums, the ELSO red book, and database entries from multiple centers registered to ELSO (3). It is a leading research center and presents its reports as "Translational Research" (9)(10)(11). Therefore, a newly designed ECLS instrument or protocol should make control studies with respect to the ELSO database.…”

“…The Penn State Hersey Pediatric Cardiovascular Research Center provides a forum for testing all cardiopulmonary support devices and equipment. It is a leading research center and presents its reports as "Translational Research" (9)(10)(11). An important characteristic of this center is that more than 600 staff members have been trained from the USA (approximately 25 centers and more than 200 staff members) and from Turkey (approximately 40 centers and more than 400 staff members) by this research center in terms of pediatric ECLS and cardiopulmonary bypass (CPB) (7,(12)(13)(14)(15).…”