Neonatal Extracorporeal Membrane Oxygenation

Mok, Yee Hui; Lee, Jan Hau; Cheifetz, Ira M.

doi:10.1097/anc.0000000000000244

Cited by 24 publications

(4 citation statements)

References 83 publications

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“…ECMO is a well-established advanced life support therapy for critically-ill children with pulmonary or cardiac failure (1). It involves technically challenging procedures and extensive multidisciplinary coordination.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

et al. 2019

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Introduction: The surgical technique for peripheral cannulation aimed at providing extracorporeal membrane oxygenation (ECMO) is well described. Training methods for surgeons still need proper standardization, especially in newborn patients. This study aims to evaluate the surgical training outcomes of a neonatal ECMO team.Materials and Methods: A 4 year training program (2014–2018) was developed to achieve the skills in the surgical technique for neonatal veno-arterial ECMO. Surgeons with experience in neonatal and vascular surgery were selected for the training. The training consisted of educational sessions, high-fidelity simulations, in vivo swine model procedures, international fellowship, and periodical simulations. The preliminary clinical experience in surgical neonatal ECMO management (2016-present) was analyzed by recording the following data: indications for ECMO and patients' data; effectiveness of cannulations (number; perioperative complications of cannulation; major surgical events during ECMO); efficacy of decannulation (number and perioperative complications).Results: 12 neonates (5 females) fitted the ELSO criteria for ECMO. Nine newborns were affected by CDH; 1 by H1N1 flu-related pneumonia; 1 by meconium aspiration syndrome and one by Respiratory Syncytial Virus related bronchiolitis. Mean weight at cannulation was 3,281 g (range 2,330–3,840 g); mean gestational age was 36 weeks. No procedure was aborted, and no intra-operatory mortality was recorded. Mean operative time was 86 ± 30 min. The caliber of the carotideal cannulas ranged from 8F (8 patients) to 10F (2 patients); the caliber of the jugular cannulas were: 8F cannula (2 patients), 10F (6 patients), and 12F (2 patients). Four complications occurred: a case of air in the circuit, two cases of azygous vein cannulation and a partial dislocation of the venous cannula during the daily care maneuvers. All of them were promptly recognized and successfully treated. The mean ECMO duration was 7.1 ± 4.2 days (range 2–16 days). Seven patients (78%) were decannulated effectively. Mean decannulation time was 53 min (range 45–80 min). No complications occurred during the decannulation process. No ECMO–related deaths were recorded.Conclusions: Neonatal respiratory ECMO still represents a challenge. Experienced neonatal surgeons can manage the neck vascular cannulation. The codified procedure must be adhered to after appropriate training and following a proper learning curve.

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Section: Discussionmentioning

confidence: 99%

“…Extracorporeal membrane oxygenation (ECMO) is an advanced life support therapy for life-threatening pulmonary and cardiac diseases in children (1). ECMO is a high-risk procedure and requires quick and effective decisions based on well-established knowledge as well as technical and organizational proficiency in an emergency setting (2).…”

Section: Introductionmentioning

confidence: 99%

Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

et al. 2019

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“…It was the same mortality rate as reported by the ELSO Registry in 2012 [ 39 ]. The proportion of neonates requiring ECMO has declined but the mortality rates for neonates supported on ECMO have increased [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative mortality in congenital diaphragmatic hernia: a single-centre observational study

Kadir

Lilja

2016

Pediatr Surg Int

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BackgroundThe management of congenital diaphragmatic hernia (CDH) is a major challenge. The mortality is dependent on associated malformations, the severity of pulmonary hypoplasia, pulmonary hypertension and iatrogenic lung injury associated with aggressive mechanical ventilation. The aims of the study were to investigate the mortality over time in a single paediatric surgical centre, to compare the results with recent reports and to define the risk factors for mortality.MethodsThe medical records of infants with CDH from two time periods: 1995–2005 and 2006–2016 were reviewed. Cox regression was used for statistical analysis.ResultsThe study included 113 infants. The mortality rate was significantly decreased in the later time period, compared to the earlier, 4.4 and 17.9%, respectively. At the early time period five patients (7.5%) were treated with ECMO and in the later time period ECMO was used in three patients (6.5%). The mortality in ECMO-treated patients was 50% in both time periods. Prenatal diagnosis, intrathoracic liver, low Apgar score and low birth weight were defined as independent risk factors for mortality.ConclusionDespite no significant differences in the incidence of independent risk factors and the use of ECMO between the two time periods, mortality decreased over time. The mortality was lower than previously reported. The results indicate that there are many important factors involved in a successful outcome after CDH repair. Large multicentre studies are necessary to define those critical factors and to determine optimal treatment strategies.

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“…Anticoagulation during ECMO was achieved by continuous heparin infusion up to 30 IE/kg/h and monitored by measuring regularly (twice a day) the activated clotting time (ACT), targeted between 150 and 200 s depending on the individual bleeding risk of a patient ( 5 ). Other coagulation parameters were also monitored routinely as consumptive coagulopathy frequently occurred during ECMO, especially within the first 24 h. For a detailed description of the physiology and clinical use of neonatal ECMO, we refer to the literature ( 6 ).…”

Section: Ecmo-system and Cannulationmentioning

confidence: 99%

Neonatal Extracorporeal Membrane Oxygenation Due to Respiratory Failure: A Single Center Experience Over 28 Years

et al. 2018

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Background: ECMO therapy is worldwide declining in the neonatal population; hence, its therapeutic value is sometimes questioned.Objectives: To report our experience with neonatal ECMO due to respiratory failure over a 28 year time period.Methods: Retrospective single center observational study including all neonates admitted to ECMO due to respiratory failure between 1989 and 2016 at Graz, Austria. Data were collected regarding survival rate, duration of ECMO, complications, length of hospital stay, changes over time, and follow-up.Results: Sixty-seven neonates were admitted and 43 (64%) needed ECMO—median birth weight 3390 grams (range 1810–4150) and gestational age 39 weeks (32–43). Survival rate was 65% (28/43); with higher rates in meconium aspiration syndrome (MAS) 89% vs. congenital diaphragmatic hernia (CDH) 46% and septic shock 44% (p = 0.005 and p = 0.006, respectively). ECMO duration was median 5 days (1–30) and veno-arterial ECMO (52%) dominated. Need for ECMO therapy decreased over time (p < 0.001). Complications occurred in 31 (72%) neonates. Five neonates had cerebral hemorrhages (11.4%) and four had cerebral infarction (9.1%). Of 26 survivors 17 (65%) showed normal neurodevelopmental outcome at median follow-up of 73 months. Motor deficits were present in one case, cognitive deficits in 9 (35%). Median length of hospital stay was 78 days in those with deficits and 29 in those with normal neurodevelopmental outcome (p < 0.001).Conclusions: Survival rate did not change over the study time but indications for ECMO did. Cognitive impairment was the major long-term deficit following neonatal ECMO being associated with longer hospital stay.

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Neonatal Extracorporeal Membrane Oxygenation

Abstract: With the overall decreasing use of neonatal ECMO, ECMO centers must find ways to maintain their expertise in the light of lower patient volumes amidst complex patient physiology.

Cited by 24 publications

References 83 publications

Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

Risk factors for postoperative mortality in congenital diaphragmatic hernia: a single-centre observational study

Neonatal Extracorporeal Membrane Oxygenation Due to Respiratory Failure: A Single Center Experience Over 28 Years

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