Short-Term Mechanical Cardiopulmonary Support Devices

The advent of successful mechanical cardiopulmonary support in children has ushered in profound changes in the management of pediatric heart failure over the past 15years. While attention has often been focused on the Berlin Heart EXCOR (which remains the only device specifically approved for use in children) (Fraser et al., 2012), improvements in short-term devices have also had a dramatic impact. Historically, extracorporeal membrane oxygenation (ECMO) provided the only option for mechanical support in children with heart failure. While the ability to provide full cardiopulmonary support continues to make ECMO a viable option for temporary support, an increasing number of ventricular assist devices are now available in sizes appropriate for many children. A thorough understanding of the devices available, their indications and contraindications, and technical nuances is critical to successful outcomes when managing children with heart failure refractory to medical management.