Therapeutic Techniques: Neonatal ECMO

Abstract

After completing this article, readers should be able to: 1. List the patient selection criteria for extracorporeal membrane oxygenation (ECMO). 2. Describe common complications of ECMO. Extracorporeal membrane oxygenation (ECMO) is a method of heart-lung bypass that has been used widely to treat respiratory failure in neonates since 1982. Although invasive, ECMO results in a 94% survival rate for infants who have meconium aspiration syndrome and have failed to improve despite optimal ventilatory support (Fig. 1 ). Multiple conditions have been treated with ECMO, including respiratory distress syndrome, sepsis, congenital diaphragmatic hernia (Fig. 2 ), persistent pulmonary hypertension, and pneumonia. Cumulatively, the overall survival of infants who receive ECMO is 80%. ECMO requires the placement of cannulas in the major blood vessels of the neck (Fig. 3 ). Support may either be venovenous (VV), with blood removed from and returned to the venous circulation via the jugular vein, or venoarterial (VA), with blood removed from the venous circulation and returned to the arterial circulation via the jugular vein and carotid artery, respectively. Blood removed from the patient undergoes gas exchange through the membrane lung and then is warmed before returning to the patient. Clotting of the circuit is prevented by heparinization. ECMO provides cardiopulmonary support while allowing the underlying pulmonary or cardiac dysfunction to resolve without the risk of further injury from barotrauma or hyperoxia. Although the conditions that may contribute to the initiation of ECMO are multiple, patient selection criteria are specific and have been standardized among ECMO centers. 1. Gestational age of at least 34 weeks. ECMO has been limited to this group because of the need for systemic …