CONGENITAL HEART DISEASE Mechanical cardiovascular support in infants and children

Extracorporeal life support (ECLS) is a general term which describes short or long term heart and/or lung support in adults and children. Within the last two decades, widespread development of different devices, systems and techniques has taken place. ECLS is used in children with combined respiratory and circulatory illness despite optimal medical and surgical treatment. Several devices for mechanical cardiovascular support (MCS) in infants and chil-dren are now well established as a bridge to cardiac transplantation or recovery.1 They include the partial support or total substitution of the heart or lungs, or both organs. The question as to which device is appropriate for which paediatric patient at what time remains unanswered. The purpose of this article is to review the technical options, rationale, and potential risks and benefits of the various devices for children. To achieve the best results at different stages of organ failure, clinicians need to be aware of the therapeutic alternatives for children in different clinical situations, and at various ages and expected durations of support. In the presence of severe respiratory failure in infants with intact hearts, the most frequently used system is extracorporeal membrane oxygena-tion (ECMO). This technique has undergone sophisticated technical development for lung (ECMO) and combined heart and lung support (ECLS) since Bartlett first reported results in 13 moribund infants in respiratory failure after surgery for congenital heart disease in 1976.2 Nowadays, in the presence of cardiac failure in patients with intact lung function, the use of MCS is preferred. These ventricular assist devices (VADs) are mechanical circulatory support systems designed to unload the heart and provide sufficient organ perfusion. There are two different VAD systems available for use in infants and children: centrifugal pumps, limited to short term application; and pneumatic pulsatile devices, which have been shown to provide adequate support for several months in conjunction with full enteral nutrition and mobilisation of the children (table 1)