Abstract
We present the first successful case of extracorporeal membrane oxygenation (ECMO) at „M.S. Curie” Emergency Clinical Hospital for Children, Newborn Intensive Care Unit: a term neonate with cardiorespiratory failure secondary to left sided congenital diaphragmatic hernia. The patient was placed on veno-venous ECMO at three days of life; however, on the fourth day, due to unstable right ventricular function, conversion to veno-arterial ECMO was mandatory. At one week of life, the patient was operated on-site for diaphragmatic hernia without ECMO support and then reintroduced on ECMO immediately after the surgical procedure, being on ECMO support for a total of 8 days. Antithrombotic treatment was administered for significant occlusion of the right common carotid artery and right internal jugular vein (complication of the cannulation for ECMO) and also long term treatment for Persistent Pulmonary Hypertension was needed. The patient was discharged at the age of four months with moderate neurodevelopmental delay. The literature review indicates that neonatal ECMO procedure in Romania is still in its early stages. Despite this state, our current case proves that ECMO can be successfully performed with increased chances of survival for neonates with severe prognosis after failure of conventional therapy.
Highlights
We present the first successful case of extracorporeal membrane oxygenation (ECMO) at „M.S
Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm that allows abdominal viscera to herniate into the chest cavity
The current paper presents the first neonate with CDH for whom ECMO procedure led to a positive outcome
Summary
Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm that allows abdominal viscera to herniate into the chest cavity. CDH remains a challenging condition, despite the progress of antenatal diagnosis and improvements in neonatal care. Multiple factors such as prematurity, associated abnormalities, severity of persistent pulmonary hypertension, type of repair and need for extracorporeal membrane oxygenation affect the survival. ECMO is an indispensable procedure for cases of neonates with severe cardiorespiratory failure that does not respond to conventional treatment as it improves oxygenation and organ perfusion. The most common candidate diseases for neonatal ECMO are meconium aspiration syndrome, persistent pulmonary hypertension of the neonate, CDH and severe sepsis[3]. The current paper presents the first neonate with CDH for whom ECMO procedure led to a positive outcome. Presentation of the Veno-venous ECMO and veno-arterial ECMO (source: www.nuemblog.com/blog/pediatric-ecmo)
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