Extracorporeal membrane oxygenation (ECMO) can be used to manage neonates with cardiac or respiratory failure. It should only be used in carefully selected patients with clear indications.


The neonate should be at least 35 weeks of gestation (a lower age is a contraindication).


Indications - all 3 of the following:

(1) one or more of the following:

(1a) persistent severe hypoxia

(1b) persistent acidosis, with pH < 7.20 despite alkalinization therapy, bicarbonate infusions and/or hyperventilation

(1c) barotrauma

(1d) cardiac dysfunction in the absence of major congenital heart disease

(2) failure of maximal medical treatment

(3) high risk for imminent mortality



• The underlying dysfunction should be reversible. This probably underlies the exclusion of major congenital heart disease.


Manifestations of severe hypoxia may include:

(1) oxygenation index > 40

(2) A-a DO2 > 400 mm Hg

(3) PaO2 < 50 mm Hg while on ventilator with PIP > 35 or mean airway pressure > 20 cm H2O


ECMO should not be used if the infant shows one or more contraindications.


To read more or access our algorithms and calculators, please log in or register.