Faheem Muhammad Shaheer Bin, Qurat Ul Ain Hafiza, Haroon-Ul-Rasheed Muhammad, Aftab Rohma
Karachi Institute of Medical Sciences, KIMS - CMH Malir, Karachi, Pakistan.
CMH Multan Institute of Medical Sciences, Multan, Pakistan.
Egypt Heart J. 2025 Mar 24;77(1):34. doi: 10.1186/s43044-025-00630-6.
Extracorporeal membrane oxygenation (ECMO), which provides life-saving assistance in severe cardiac and pulmonary failure cases, has emerged as an important technique in managing children with congenital heart disease (CHD).
In this review, we discuss the evolution of ECMO over the years, its clinical uses, and the results in pediatric CHD. ECMO has been utilized as a bridge to recovery, in stabilizing an individual after surgery, and as a bridge to heart transplantation. Cannulation procedures that are adjusted according to the anatomy of an individual have improved outcomes, although bleeding and neurologic concerns remain a matter of concern. In addition, long-term neurodevelopmental disorders and renal failure are also among the alarming outcomes. The use of newer anticoagulant drugs like bivalirudin, which lowers the risk of bleeding, and genomic testing for personalized treatment are examples of recent developments. Furthermore, neuroprotective techniques such as erythropoietin and dexmedetomidine can also enhance the neurocognitive outcomes. Finally, improvements in monitoring systems and pump technology contribute to increased ECMO efficacy and safety.
Despite these developments, ECMO's expense and restricted accessibility remain major obstacles, especially in areas with low resources. In this review, the advancements in ECMO technology and care are highlighted, and it also emphasizes future research to address the current challenges.
体外膜肺氧合（ECMO）在严重心肺功能衰竭病例中提供挽救生命的支持，已成为治疗先天性心脏病（CHD）患儿的一项重要技术。
在本综述中，我们讨论了多年来ECMO的发展历程、其临床应用以及在小儿CHD中的治疗结果。ECMO已被用作康复的桥梁、术后稳定个体状况的手段以及心脏移植的桥梁。根据个体解剖结构调整的插管程序改善了治疗效果，尽管出血和神经方面的问题仍然令人担忧。此外，长期神经发育障碍和肾衰竭也是令人担忧的后果。使用新型抗凝药物如比伐芦定可降低出血风险，以及进行基因检测以实现个性化治疗，这些都是近期的进展。此外，诸如促红细胞生成素和右美托咪定等神经保护技术也可改善神经认知结果。最后，监测系统和泵技术的改进有助于提高ECMO的疗效和安全性。
尽管有这些进展，但ECMO的费用和可及性受限仍然是主要障碍，尤其是在资源匮乏地区。在本综述中，突出了ECMO技术和护理方面的进展，同时也强调了应对当前挑战的未来研究方向。
