A decade of experience with neonatal extracorporeal membrane oxygenation☆,☆☆,★
Section snippets
NEONATAL DISEASES AND CONDITIONS TREATED WITH ECMO
One of the findings of the National Institutes of Health-sponsored study of ECMO in adult patients was the pathologic demonstration of extensive pulmonary fibrosis.2 This was believed to be a major reason for the failure to demonstrate any advantage of the use of ECMO. It was apparent that if the technique was to have any clinical application, it had to be used in patients with readily reversible diseases or conditions. This requirement led investigators to pursue the use of ECMO in the
CRITERIA
Because the invasiveness of extracorporeal life support and the potential complications may result in death or significant long-term neurologic sequelae, clinical investigators were initially reluctant to use this treatment unless the patients were at great risk of dying of their primary disease. Criteria were developed to identify those patients with a predicted mortality rate of 80% or greater.1 The criteria were generally determined by a retrospective chart review of patients treated at an
PREPARATION OF PATIENTS, CANNULATION, AND ECMO MANAGEMENT
My colleagues and I currently begin considering ECMO for patients with neonatal pulmonary disease, who are otherwise eligible, when the OI is 20 to 25. Generally at this point the condition has progressed in severity so the oxygen requirement is 100%, and the patient is usually undergoing hyperventilation; the Pao2 usually is 100 mm Hg or less. Cardiac consultation is obtained to ensure the absence of significant congenital heart disease and to assess ventricular function. It is preferable to
Mortality rate
The Extracorporeal Life Support Organization (Ann Arbor, Mich.) is an umbrella organization of institutions at which ECMO is currently being provided. Composed predominantly of centers within the United States, the organization was incorporated in 1989 and assumed the responsibility for maintaining the Neonatal ECMO Registry, which was established in the early 1980s by the Ann Arbor group under the leadership of Robert H. Bartlett, MD. The purpose of the registry was to serve as a repository
ISSUES AND CONCLUSIONS
Although there has been appropriate concern regarding the use of ECMO in the treatment of neonatal respiratory failure during the initial stages of clinical use, there is no doubt that ECMO can be used successfully to support neonates with hypoxemia resulting from the described conditions, and the result is an apparent reduction in the mortality rate. We believe that the use of ECMO in the management of MAS unresponsive to conventional medical therapy is now a standard of care; deaths
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Cited by (74)
Pediatric Extracorporeal Membrane Oxygenation: An Introduction for Emergency Medicine Physicians
2015, Journal of Emergency MedicineCitation Excerpt :Extracorporeal membrane oxygenation (ECMO) is the use of a modified cardiopulmonary bypass machine that provides cardiac support, blood oxygenation, and carbon dioxide removal in patients with reversible cardiac or respiratory failure. In the neonatal intensive care unit (NICU), ECMO use has become standard of care with survival rates > 85% in neonates as a final rescue therapy, with severe and refractory hypoxemia secondary to meconium aspiration, respiratory distress syndrome, and primary pulmonary hypertension prompting uses from the neonatal population to the pediatric (1). Most of the literature on ECMO use with pediatrics relates to its use in the pediatric intensive care unit (PICU), but with this expanded patient selection criteria and simplified, more compact systems, ECMO is now a possible treatment option for more pediatric patients who are failing conventional treatment in the emergency department (ED).
Neonatal Respiratory Disease
2011, Pediatric Critical Care: Expert Consult Premium EditionNeonatal Respiratory Disease
2011, Pediatric Critical CareNeonatal Respiratory Disease
2006, Pediatric Critical CareNeonatal Respiratory Disease
2005, Pediatric Critical Care, Third EditionTransport Of Ventilated Infants
2003, Assisted Ventilation of the Neonate
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From the Department of Pediatrics, Medical College of Georgia Children's Medical Center, Augusta
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Reprint requests: William P. Kanto, Jr., MD, Department of Pediatrics, Medical College of Georgia Hospital and Clinics, Augusta, GA 30912-3740.
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0022-3476/94 $3.00 + 0 9/18/52156