All pediatric clinicians should be aware not only of the potential benefits and complications of ECMO but also that survivors need effective screening, support, and follow-up.

The 2009 influenza A(H1N1) pandemic, along with randomized clinical trials of adult respiratory ECMO support and conventional management, have catalyzed sustained growth in the use of ECMO. The adult trials built on earlier neonatal ECMO randomized clinical trials that demonstrated improved survival in severe perinatal lung disease.

For children outside of the neonatal period, there appear to have been no respiratory ECMO clinical trials.

Applying evidence from adult respiratory failure or perinatal lung disease to children outside the neonatal period has important potential pitfalls.

For these children, the underlying diseases and risks of ECMO are different.

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