Extracorporeal life support: updates and controversies

Samir K Gadepalli; Ronald B Hirschl

doi:10.1053/j.sempedsurg.2014.11.002

Extracorporeal life support: updates and controversies

Semin Pediatr Surg. 2015 Feb;24(1):8-11. doi: 10.1053/j.sempedsurg.2014.11.002. Epub 2014 Nov 7.

Authors

Samir K Gadepalli¹, Ronald B Hirschl²

Affiliations

¹ Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: samirg@med.umich.edu.
² Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.

PMID: 25639803
DOI: 10.1053/j.sempedsurg.2014.11.002

Abstract

The use of Extracorporeal Life Support (ECLS) in children and adults has markedly increased during the past few years with over 4000 patients placed on ECLS every year in over 200 centers. This article focuses on updates to the physiology and mechanics of ECLS with use of magnetically levitated centrifugal pumps, hollow-fiber gas-exchange devices, and bi-caval dual-lumen catheters. We also explore controversies in management including indications, cannulation approaches, renal replacement, monitoring of anticoagulation, early ambulation, and termination of ECLS. Finally, we present changes in the systems that provide ECLS including the single-provider model and regionalization of care.

Keywords: Anticoagulation; Continuous renal replacement therapy (CRRT); Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO); Neonatal critical care; Pediatric critical care.

MeSH terms

Extracorporeal Membrane Oxygenation / methods*
Humans
Respiratory Insufficiency / surgery*