Historical Perspectives

Abstract

In 1984 and 1985, we conducted a prospective randomized trial of extracorporeal life support (ECLS) versus conventional treatment in neonatal respiratory failure that was reported in Pediatrics in 1985. (1) Two decades, later ECLS is standard treatment for neonatal respiratory failure that is unresponsive to other methods of management. The editors of NeoReviews have invited this commentary on the development and clinical implementation of ECLS in neonatal respiratory failure. The heart-lung machine was invented by John Gibbon and initially used clinically in 1954 to replace heart and lung function long enough to allow operations on the heart. The entire field of cardiac surgery resulted from this invention. However, the heart-lung machine itself caused blood damage and multiple organ failure when used for more than 1 hour. The major cause of blood damage was direct exposure of the blood to oxygen gas. In the 1960s, some laboratories and medical device companies developed gas exchange devices in which a silicone rubber membrane was interposed between the blood and the oxygen. This modification (and others) allowed the use of a heart-lung machine for days or weeks. In 1971, prolonged extracorporeal circulation was used successfully to treat a young man who had acute respiratory distress syndrome (ARDS) after trauma. (2) In the next few years, several other cases were reported using prolonged extracorporeal support to treat cardiac failure and respiratory failure from a variety of causes. Because the membrane type of artificial lung was the unique part of the device, the entire technology of prolonged ECLS came to be known as extracorporeal membrane oxygenation (ECMO). Of course, the technology involves much more than oxygenation, but that acronym has remained. In 1975, the National Institutes of Health (NIH) sponsored a prospective, randomized, multicenter trial of ECMO for ARDS in adult patients. (3) Only 10% of …