Management of veno-arterial ECMO in infants and children

Abstract

VA support remains common in neonates and children placed on extracorporeal membrane oxygenation (ECMO) for respiratory, cardiac or combined dysfunction. 1 Providing adequate ECMO flow to reverse tissue oxygen debt is imperative in the first few hours of ECMO. Several studies outline the poor outcome which results if lactic acidosis and pH do not improve after institution of ECMO. Following serial lactate, urine output, and other signs of organ perfusion are vital aspects of care. For infants and children, the common route for adequate vessel size is use of the right internal jugular vein and right common carotid artery. Some centers also utilize a venous drainage cannula placed retrograde up the internal jugular vein to the level just below the jugular bulb to augment venous drainage. Whether this also reduces risk for venous congestion in the brain is unknown. Older children (usually at least 15 kg or 2–3 years old) may be supported via the femoral vessels (vein and artery) or a combination of cervical ...