Objective: For children with severe heart failure in whom medical management has failed, mechanical circulatory support in the form of either extracorporeal membrane oxygenation or ventricular assist device represents life-sustaining therapy. This review provides an overview of these two modalities, including a discussion of indications, contraindications, timing, and device selection, as part of the Pediatric Cardiac Intensive Care Society/Extracorporeal Life Support Organization Joint Statement on Mechanical Circulatory Support. DATA SOURCES, STUDY SELECTION, DATA EXTRACTION: PubMed was searched using the following terms: ECMO, extracorporeal membrane oxygenation, ventricular assist device, VAD, and pediatric. Case reports, single-center series, multicenter studies, and registry reports were reviewed.
Conclusions: The two technologies have unique advantages and disadvantages and may be considered complementary devices, although they are frequently used in sequence. Either modality may be used as bridge-to-transplant or bridge-to-recovery, and the choice of device and device timing is influenced by the acuity of illness, comorbidities, potential for recovery, and anticipated duration of support.