ECMO-/ECLS

60% using DLVV. Intracranial complications were far less frequent in pediatric
patients, though survival was much lower when they occurred. [ 4 ]
Overall, a second ECLS run was required in pediatric patients only 3% of the
time. The rate was higher in patients on VA ECMO and for cardiac dysfunction.
There were no differences in survival for a second run, however, among non-
survivors, there was a higher rate of renal failure during the first run and there
was higher rate of complications during the second run. About 5% of patients
undergo a repeat ECLS run after an index run post cardiac surgery. The overall
survival to discharge is about 25%, with non-survivors having a six-fold higher
incidence of renal failure. Finally, in patients who underwent multiple runs,
neurologic and infectious complications increased the most[ 4 ].
ECLS has been effective in other clinical situations such as in blunt
trauma in children and adults where survival rates approximate 65%. Although
thermal injury was previously considered a contraindication, ECLS has been
applied in pediatric patients after significant body surface burns with excellent
survival. ECLS has also been successfully applied to patients undergoing
tracheal repair, to those with alveolar proteinosis who require lung lavage, and to
those with lung hypoplasia due to in-utero renal insufficiency, asthma, sickle cell
disease, and lung failure following lung transplantation[ 3 ]. Another growing
application of ECLS has been in the form of extracorporeal cardiopulmonary
resuscitation (ECPR) in adult or pediatric patients with cardiogenic shock, post
traumatic hypotension, hypothermia, arrhythmias, and cardiac arrest. Favorable
neurologic outcome was noted in about 80-90% of the survivors on short-term