ECMO use in infants with bronchopulmonary dysplasia: a literature review

Bronchopulmonary dysplasia (BPD) is a leading cause of chronic respiratory failure in infants. Severe BPD is associated with prolonged mechanical ventilation, pulmonary hypertension, and high morbidity and mortality. As disease severity increases, extracorporeal membrane oxygenation (ECMO) is being reconsidered as a potential rescue therapy. Historically, ECMO has been reserved for neonates with reversible respiratory failure and those who required mechanical ventilation for less than 14 days, while infants with BPD were excluded. However, advancements in ECMO technology, anticoagulation strategies, and ventilatory management have led to a reassessment of its role in this population. Emerging reports suggest ECMO may serve as a bridge to recovery or lung transplantation for select infants with severe BPD and refractory respiratory failure. Careful patient selection remains critical, considering factors such as pulmonary hypertension severity, right ventricular dysfunction, and potential for lung recovery.