Special considerations for neonatal ECMO

Abstract

Extracorporeal membrane oxygenation (ECMO) describes extended extracorporeal cardiopulmonary support for acute, severe, reversible cardiac and respiratory failure unresponsive to conventional medical management. ECMO provides cardiopulmonary rest, while allowing the underlying pulmonary or cardiac dysfunction to resolve without the risk of further injury from hyperoxia and baro-trauma. This involves bypassing the pulmonary circulation to effect oxygenation external to the body. It requires extrathoracic vascular cannulation for extended periods of time, usually ranging from 3 to 20 days, as well as adequate anticoagulation to prevent thrombus formation throughout the circuit. ECMO is indicated as a supportive intervention for infants of > 2.0 kg and > 34 weeks gestational age, who are at high risk of dying despite optimal treatment [1]. It has been used in newborns for multiple intractable conditions, including respiratory distress syndrome/hyaline membrane disease, sepsis/pneumonia, congenital diaphragmatic hernia, meconium aspiration syndrome, persistent pulmonary hypertension, and congenital heart disease. This chapter focuses on the imaging of patients on ECMO, including the technical devices required (circuit and cannulae) and ECMO complications. Correct placement of ECMO cannulae: a radiological assessment Neonatal ECMO requires the placement of cannulae in the major blood vessels of the neck. Support may be either venovenous (VV) or venoarterial (VA). Venovenous ECMO In VV ECMO, the blood is removed from and returned to the venous circulation via the right internal jugular vein into the right atrium (RA). This mode of support relies on native left ventricular function for delivery of oxygenated blood to the systemic circulation.