J.Jpn. Surg. Soc.. 121(6): 579-585, 2020

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EXTRACORPOREAL MEMBRANE OXYGENATION IN PEDIATRIC SURGERY

Extracorporeal membrane oxygenation (ECMO) is extremely useful for respiratory support in neonates and infants with respiratory insufficiency. Of the pediatric patients registered with the Extracorporeal Life Support Organization (ELSO), 30％ had undergone ECMO due to neonatal respiratory failure, and 20％ due to nonneonatal respiratory failure. ELSO reported that 64％ to 73％ of neonates receiving ECMO for respiratory support survived to discharge, compared with 59％ of nonneonatal patients receiving it. The prognosis for severe congenital diaphragmatic hernia has improved with the control of persistent pulmonary hypertension in newborns using advanced medical therapy. In Japan, the incidence of ECMO has dramatically declined to 7％, as it is only applied to selected patients. Recently, tremendous advances have been made in research on artificial wombs using ECMO for fetuses. Partridge et al. developed a novel artificial womb and successfully fostered a lamb fetus, which is biologically equivalent to a human infant at 23–27 weeks’ gestation, for up to 4 weeks in a plastic bag filled with artificial amniotic fluid. They demonstrated that the fetal lamb respiratory function and central nervous system developed normally inside their artificial womb.

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