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Preface As with all historic events, there are many crossroads that occur, with key elements and/or people at each turn, directing the movement forward. In the late 1940 and early 1950s the fields of cardiovascular surgery and nephrology were emerging, with leaders in the fields working on artificial systems to support the heart for cardiac surgery and the kidney during renal failure. In 1944, investigators working on an artificial membrane for dialysis observed that blood became oxygenated as it passed through the cellophane chambers of their membrane. This historic observation led to the recognition by those involved in the fast-developing field of cardiopulmonary bypass, that blood could be oxygenated through a semipermeable membrane lung. Bubble and disk oxygenators used during the early 1950s for open heart surgery required oxygen and blood to mix directly. This mixing resulted in considerable damage to blood products and the potential for producing lethal fibrin emboli, making these systems unsuitable for prolonged clinical use. For this reason, and in light of the nephrologists’ findings, attention was directed to the development of semipermeable membrane oxygenators that separate blood and oxygen, decreasing or eliminating the risks of the earlier oxygenators. The first membrane lung using an ethylcellulose membrane was successfully used in open heart surgery in 1956. With this report began the study of prolonged cardiopulmonary bypass and the potential application of extracorporeal membrane oxygenation (ECMO) as an artificial lung. The 1960s witnessed intensive research on materials and techniques. Silicone polymers, available in thin sheets that enhanced gas transfer through membranes, began to be characterized and developed. The development of the silicone membrane lung made the field of extracorporeal membrane oxygenation (ECMO) possible, and clinical trials, using prolonged bypass or ECMO as an artificial lung, began in the late 1960s. Early investigators attempted to use ECMO as an artificial placenta, focusing their efforts on use in the premature infant. The heparinization and technical limitations at the time resulted in a high mortality rate secondary to intracranial hemorrhages, although the ability to oxygenate and remove carbon dioxide were found to be adequate. Dr. Robert Bartlett considered the “father of ECMO therapy,” focused his efforts on the term infant in respiratory failure, reporting the first successful use of ECMO in a term infant with meconium aspiration syndrome in 1975, changing the focus

for those involved in extracorporeal support research. His efforts allowed investigators to continue to work on the concept of ECMO as an artificial lung, with ECMO now an established therapy for newborns, pediatric and adult patients in respiratory failure. In this edition, our authors describe the use of ECMO in the newborn, both for respiratory support and for cardiac support, providing recent outcome data and technical changes that have occurred over the years. The ECMO Registry was instituted in 1984 under the leadership of Dr. Bartlett to provide an outcome database of the ECMO population, allowing this new technology to be prospectively and retrospectively studied and evaluated. Drs. Paden, Thiagarajan, and Peter Rycus provide an excellent overview of the registry and recent outcome data by newborn diagnoses across 100þ ECMO centers involved in this database. New techniques including the use of venovenous vs venoarterial ECMO are outlined in the article by Drs. VanMeurs and Rais-Bahrami. Specific disease states treated by ECMO, including a discussion of newer therapies that can result in a decreased need for ECMO are discussed in the articles by Drs. Nair and Lakshminrusimha for persistent pulmonary hypertension and Drs. Badillo and Gingalewski for the patient with congenital diaphragmatic hernia. Of importance in all high-risk invasive therapies is the outcome related to the therapy. Drs. van Heijst and IJsselstijn provide an extensive overview of the known outcome studies (neurodevelopmental and physical) in the ECMO population, along with a discussion on the neuroimaging findings and their relationship to long-term outcome in this population. Expansion of ECMO from neonatal respiratory failure to postoperative cardiac support for the newborn with congenital heart disease started in the early 1980s. An excellent review of the outcome and newer extracorporeal procedures used today in this population is provided by Drs. McMullen and Mesher in their article on this population. As with many therapies, we now have come full circle. In the article by Drs. Bryner and Mychaliska, the use of ECMO as an artificial placenta is again being studied. New techniques and smaller, less-invasive equipment available today have allowed this concept to resurface and the recent research and direction for this use of ECMO is outlined in this article. This has been an exciting journey for those involved in the development and study of extracorporeal life support

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(ECLS), a journey coupled with exciting research and development of newer therapies for newborn infants in respiratory and cardiac failure. I am excited about the opportunity to bring forward the latest on ECMO/ECLS therapy in the newborn infant in this edition of Seminars in Perinatology through the words of my colleagues and experts in the field of ECLS.

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Billie Lou Short, MD Division of Neonatology Children’s National Medical Center Washington, DC 0146-0005/14/$ - see front matter & 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1053/j.semperi.2013.11.001

Cardiovascular surgery and nephrology.

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