Clinical experience of more than 2 months usage of extracorporeal membrane oxygenation (Endumo®4000) without circuit exchange

Abstract

A 5-year-old girl with right atrial isomerism, complete atrioventricular septal defect, hypoplastic left ventricle, double outlet right ventricle, and mixed-type total anomalous pulmonary venous connection with totally occluded left pulmonary veins presented at our center for fenestrated total cavo-pulmonary connection with an extra cardiac conduit at the age of 3 years. Eleven months after the Fontan completion, she developed protein-losing enteropathy (PLE). Spontaneously closed fenestration was thought to be the cause of the PLE, and she underwent revision of fenestration at the age of 5 years. After the operation, PLE did not improve, and newly developed hypoxemia impaired her systemic ventricular function, leading to the initiation of veno-arterial extracorporeal membrane oxygenation (ECMO) with the Endumo(®) system 18 days after the operation to treat her hemodynamic instability. Although the ECMO circuit was changed three times during the first 8 days, the fourth circuit could be used for 74 days without hemolysis and serum leakage, until the patient unfortunately died 82 days after the operation due to multi-organ failure.

Efficacy of “Awake ECMO” for critical respiratory failure after pediatric open-heart surgery

“…Safe long-term use of the Endumo system without circuit exchange and the possibility of ''Awake ECMO'' under such stable ECMO support had been already reported [4]; however, this research reports the first successful weaning off from ECMO support after severe respiratory failure following a complex congenital heart surgery using the ''Awake ECMO'' procedure. Although the recovery of respiratory function was mainly achieved through the improvement of ARDS by resting lung therapy under venoarterial ECMO support, there is no doubt that the recovery from critically reduced tidal volume incurred due to a subsequently occurring massive pulmonary hemorrhage was truly obtained by the effective respiratory physical therapy with the ''Awake ECMO'' procedure.…”

Preclinical biocompatibility study of ultra-compact durable ECMO system in chronic animal experiments for 2 weeks

“…Hoashi et al [12] reported on prolonged cardiopulmonary support in neonates and infants with a median support period of 21.7 days. Kusajima et al [13] described the continuous use of a single ECMO circuit for 74 days, which did not result in hemolysis or serum leakage.…”

Journal of Artificial Organs 2014: the year in review

“…Kusajima et al [24] of the National Cerebral and Cardiovascular Center reported a pediatric case of over 2-month ECMO. A girl patient with complicated congenital heart disease underwent fenestrated total cavopulmonary connection with extra-cardiac conduit at 3 years old.…”