The extracorporeal life support (ECLS) program at Arkansas Children's Hospital is one of the most advanced in the nation. The ECLS program incorporates cutting edge technology with the highest level of teamwork to provide life-saving support for the most critically ill children. At Arkansas Children's Hospital, ECLS includes the use of both ECMO (extracorporeal membrane oxygenation) and VAD (ventricular assist device) support. Since the inception of the program in 1989, ECLS at Arkansas Children's Hospital has contributed to life-saving care for hundreds of patients.

Care Provided:

• Support to approximately 50 patients annually with severe cardiac and/or respiratory failure
• Provides ECMO support to patients from around the state and region
• Rate of survival to hospital discharge equals or exceeds the average rate reported from all centers participating in the Extracorporeal Life Support Organization registry
• Rate of survival of patients transported to ACH on ECMO support equals or exceeds ELSO survival rates and “in-house” survival rates

About ACH ECMO Transport

Among the national and international ECMO centers, ACH has one of the largest experiences to offer air transport of critically ill patients on an ECMO circuit. Mobile ECMO features include:

• Helicopter Transport (two Sikorsky S-76 C+ aircraft)
• Jet Transport (ACH has fixed-wing aircraft available for longer distances through local vendors)
• Ground Ambulance (three ground ambulances include the ability to transport two isolettes, Mobile ECMO and more)

For ECMO support referrals, call Angel One Dispatch at 1-800-ACH-HELP. Ask to speak to the pediatric intensivist, cardiac intensivist or neonatologist on call, depending on the age of the child and primary problem.

ECMO Selection Criteria

The need to escalate to ECMO support can be a difficult decision for a referring physician. Arkansas Children’s Hospital has developed selection criteria to help guide you through this process. The decision to transfer to an ECMO center begins with early consultation to allow for logistics for transport. We hope the following information will help answer some of the questions your team may have. For an ECMO transport call 1-800-ACH-HELP.

Neonatal ECMO

• Birth weight > 1.8 kg
• Gestational age > 34 weeks
• No major bleeding problems
• Less than 10 days mechanical ventilation
• Normal head ultrasound of if IVH present it must not be > than grade 1 hemorrhage.
• No coagulothapy
• Disease process that is felt to be reversible.
• Oxygen index ( OI ) of > 40 for more than 2 hours. (OI=Mean airway pressure x Fio2 x 100/PaO2)

Pediatric ECMO

The pediatric ECMO criteria have no hard set criteria, but here are some things to consider.

• No major bleeding problems
• No multi-organ failure
• Less than 7 to 14 days on high mechanical or high-frequency ventilator settings.
• 1 month to 18 years of age
• Pneumonia
• Flu
• Acute respiratory failure
• Trauma
• Aspiration
• Near drowning
• Sepsis
• Status asthmaticus
• Other reversible lung disease

Cardiac ECMO

This is the most difficult population to give criteria for, the decision to place a pediatric cardiac patient on ECMO involves many factors. Echocardiography and Cath labs are great tools to help in this decision process, but we understand many centers may not have access to this equipment.

The following is a general list of the different type of cardiac patients that may be placed on ECMO support.

• Post cardiac arrest
• Cardiogenic shock
• Cardiac failure post heart surgery
• Pulmonary hypertension
• Myocarditis
• Congenital heart defects pre or post surgical with chance of survival
• Bridge to transplant
• Bridge to LVAD or other mechanical device.