Extracorporeal Membrane Oxygenation (ECMO) for Neonatal Respiratory Failure: Experience from the Extracorporeal Life Support Organization (ELSO)

Abstract

Gibbon began developing the heart-lung machine in 1937, (13) and began the era of open cardiac surgery in 1954. The use of an artificial pump and lung, however, was limited to 1 or 2 h, not because of the pump, but because the oxygenator severely altered blood cells and proteins. The first membrane oxygenator built and used clinically was reported in 1956 by Clowes and his coworkers (10). With the introduction of silicone rubber as a membrane for gas transfer, the membrane oxygenator became practical for long-term cardiopulmonary bypass (18). Extracorporeal circulation for respiratory failure was first attempted in newborns by Rashkind and associates (23). After a series of laboratory studies, Bartlett and coworkers began clinical trials of ECMO in 1972, and reported the first successful use of ECMO in newborn respiratory failure in 1976 (4). Subsequently, several groups were successful using Bartlett’s technique (15, 6, 28, 29). As of January 1992, ECMO has been used in the management of over 5863 neonates in 83 centers worldwide (13 outside the USA) with an overall survival rate of 82 % [12]. This observation alone is sufficient to establish ECMO as therapeutically effective, since infants in these centers are treated only after they meet criteria predicting an 80 % mortality.