peak inspiratory pressure 40 cmH 2 O and an A-aDO 2 > 580 mmHg have been
used to predict mortality and a need for ECLS initiation.[ 17 ] In fact, the ELSO
registry would suggest that the indication for ECLS is simply classified as “failure
to respond” in >90% of pediatric respiratory failure patients. Similarly, criteria for
initiation of ECLS in pediatric patients with cardiac insufficiency are poorly
defined and include clinical signs such as decreased peripheral perfusion,
oliguria (urine output < 0.5 ml/kg/hr), core hyperthermia, and hypotension despite
administration of inotropic agents or volume resuscitation. [ 5 ] ECLS is applied in
pediatric cardiac patients in the setting of cardiogenic shock, cardiac arrest,
acute deterioration, and in the operating room due to inability to wean from heart
lung bypass.
Previous contraindications to ECLS have been reevaluated and the
criteria for inclusion broadened. ECLS may be successfully applied in the
preterm newborn with EGA > 30 weeks and birth weight > 1 gram, although the
incidence of ICH may be higher.[ 18 ] Development of ICH or extension of a
previously present ICH was nonexistent when heparin administration was
minimized and a proximal venous drainage cannula placed.[ 19 ] Reasonable
outcomes have also been demonstrated when ECLS has been instituted in the
setting of grade I ICH regardless of age group.[ 20 ] Mechanical ventilation pre-
ECLS is no longer considered a contraindication to ECLS; although initiation of
ECLS earlier in the course of respiratory insufficiency may reduce morbidity and
mortality, survival in patients who have been managed with mechanical
ventilation for up to 10 to 14 days may still be reasonable.[ 3 ] Cardiac arrest is