Extracorporeal membrane oxygenation (ECMO) for heart failure in children: a review of current practice

Mechanical circulatory support (MCS) is a valuable treatment modality for a small proportion of children with heart failure who are refractory to conventional medical management. Advances in MCS technology, particularly in recent times with the advent of ventricular assist devices (VADs) has made it possible to offer life support for this diverse population. ECMO has historically been used to provide temporary support for children with heart failure either as a bridge to recovery and occasionally as a bridge to heart transplantation, particularly in the pre-VAD era. In contemporary practice, ECMO may be used in refractory end-stage heart failure with end-organ dysfunction as a bridge to decision regarding transplant candidacy or as a bridge to a durable MCS device pending recovery of other end-organ dysfunction. The management of a child supported on ECMO is complex and requires multidisciplinary expertise. Ensuring optimal conditions for myocardial rest and recovery whilst mitigating for complications remains challenging. Cumulative experience has shown that although survival has improved there are a growing number of ECMO survivors in need of long-term follow-up. In this review, we will focus on children with systolic heart failure requiring ECMO as a form of MCS given the established role of VADs in paediatric heart failure.