Critical & Organ Care · 1975
Extracorporeal membrane oxygenation (ECMO) for neonatal respiratory failure (Bartlett)
On July 14, 1975, a newborn with severe meconium aspiration syndrome arrived at UC Irvine unable to maintain adequate oxygenation on conventional mechanical ventilation. Robert Bartlett's surgical team, drawing on experience with extracorporeal circuits in cardiac surgery, placed her on venoarterial ECMO. The infant, whom the nurses named Esperanza, survived after 72 hours on the circuit. It was the first documented neonatal ECMO survival.
The principle behind ECMO was not new: cardiopulmonary bypass had kept patients alive during open-heart surgery since the 1950s. Extending that support over days rather than hours for newborns with reversible lung disease required a different approach entirely. Bartlett's group developed anticoagulation protocols calibrated for neonatal physiology, designed smaller circuits to minimize priming volume, and worked out how to manage the circuit continuously in an ICU rather than a sterile operating theatre.
Skepticism within neonatology was substantial. The circuit required systemic heparinization, and intracranial hemorrhage was a real risk in premature and term newborns alike. Critics also noted that survival bias and selection effects made early case series difficult to interpret. The field's credibility issues were significant enough that when Bartlett later ran a randomized trial of ECMO versus conventional treatment in neonates, he used an adaptive randomization design that drew controversy for its unconventional statistical approach, even as the results clearly favored ECMO.
Bartlett's group published a series of 45 patients in 1982 with survival rates far above those seen in historical controls receiving conventional ventilation for comparable diagnoses. The FDA cleared neonatal ECMO for respiratory failure in 1992, by which point dozens of specialized centers had adopted the technique. The Extracorporeal Life Support Organization, founded in 1989, created registries and training standards that standardized practice across institutions.
The application broadened over subsequent decades. ECMO for adult ARDS gained renewed interest after the 2009 H1N1 influenza pandemic, and extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest is now offered at major cardiac centers. Neonatal ECMO remains standard rescue therapy for term newborns with reversible causes of severe hypoxic respiratory failure, including meconium aspiration, congenital diaphragmatic hernia, and persistent pulmonary hypertension.
Key People
- Robert Bartlett — Surgeon at UC Irvine who performed the first successful neonatal ECMO run in 1975.
- J. Donald Hill — Surgeon who pioneered early adult ECMO use in the 1970s, informing Bartlett's neonatal work.
- Gail Annich — ECMO specialist whose later work shaped pediatric anticoagulation protocols.
J Thorac Cardiovasc Surg, 1977 (first clinical series; index case 1975)
Related landmarks
- 1971 · Naloxone approved as an opioid overdose antidote (Critical & Organ Care)
- 1980 · Exogenous surfactant therapy for neonatal respiratory distress syndrome (Fujiwara) (Critical & Organ Care)
- 1968 · Harvard Criteria for Brain Death (Critical & Organ Care)
- 1989 · First Successful Living-Donor Liver Transplant (Critical & Organ Care)