Pediatric Extracorporeal Membrane Oxygen

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Abstract
Mortality from acute respiratory failure (ARF) in children remains distressingly high at roughly 60% with little improvement over the past years.1The sporadic use of extracorporeal membrane oxygenation (ECMO) for management of ARF should, therefore, not be surprising; the article by Scalzo et al in this issue ofAJDCis one of a number of anecdotal reports of this application. Is ECMO a real advance in the care of children with ARF? We suggest that the answer may well be "no," and urge that ECMO for ARF in outside the neonatal period be critically studied now, lest it become widely used without proof that it is beneficial (which appears to have happened for neonatal ECMO). Extracorporeal membrane oxygenation was used frequently for ARF in adults during the 1970s. However, a multicenter collaborative study comparing ECMO with conventional therapy was very discouraging, reporting 90% mortality in both groups,2and