Extracorporeal membrane oxygenation for pediatric cardiopulmonary failure

Anderson, Harry L.; Attorri, Robert J.; Custer, Joseph R.; Chapman, Robin A.; Bartlett, Robert H.

doi:10.1016/s0022-5223(20)31457-4

Cited by 53 publications

(7 citation statements)

References 8 publications

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“…Early surgical mortality remains significant even in the best of cases, with mortality reported at 5–8% [1, 2]. Patients requiring ECMO support prior to or following cardiac surgery have a dramatically increased mortality rate, with several sources quoting 32–40% survival rate in these patients [3–9] clearly, these preoperative conditions have and adverse outcome on surgical survival.…”

Section: Discussionmentioning

confidence: 99%

Preoperative palliation of newborn obstructed total anomalous pulmonary venous connection by endovascular stent placement

Kyser

Bengur

Siwik

2006

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Preoperative palliation of newborn obstructed total anomalous pulmonary venous connection by endovascular stent placement

Kyser

Bengur

Siwik

2006

Cathet Cardio Intervent

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“…At the initiation of ECMO, preexisting central shunts have to be occluded or at least restricted to prevent excessive pulmonary flow (5). During treatment, cardiac contraction and ejection should be assessed on a regular basis by echocardiography and assisted with inotropic agents (17), particularly in patients in whom the left ventricle is not vented.…”

Section: Functional Aspects and Managementmentioning

confidence: 99%

“…In children of 2 to 3 years or younger and routinely in infants, the cannulas are placed into the internal jugular vein and the common carotid artery (17,22,23). The venous cannula is placed with the multiple perforations at its end within the right atrium.…”

Section: Vascular Access and Cannulation Techniquesmentioning

confidence: 99%

“…The risks of cannulation of the common carotid artery are wall dissection, left ventricular distension, impaired right cerebral function, ipsilateral cerebral neurological functional abnormalities, and subclavian steal (24,26). The general opinion is divided on the issue as to whether or not the ligated vessels should be reconstructed in those children in whom the risk of neurological injury is already high (17,27,28). On the other hand, the uncertain advantage of reconstruction with risk of reperfusion injuries and embolic events has to be taken into consideration.…”

Section: Vascular Access and Cannulation Techniquesmentioning

confidence: 99%

“…Postoperative patients with uncontrolled hemorrhage, massive hemolysis, air embolization, intubation for more than 10 days, and unsatisfactory repair are also poor candidates (10,17,42).…”

Section: Contraindicationsmentioning

confidence: 99%

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Surgical Aspects of Pediatric Cardiac Extracorporeal Membrane Oxygenation

Wollenek

Czerny²,

Golej

1999

Artificial Organs

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Because children with severe myocardial dysfunction have limited therapeutic options, mechanical support of a failing heart is a matter of great interest. In the setting of cardiogenic shock or severe low cardiac output and hypoperfusion, extracorporeal membrane oxygenation (ECMO) can produce decisive improvements. The criteria for successful treatment include appropriate patient selection, improved surgical techniques and experience, higher recognition and anticipation of complications, and minimized delay in initiation of ECMO. Because the need for mechanical circulatory support may arise pre-, intra-, and postoperatively, every pediatric cardiac surgeon must be familiar with the principles and the surgical aspects of ECMO.

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Extracorporeal Membrane Oxygenation

Conrad

Scott

2006

Wiley Encyclopedia of Biomedical Engineering

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Extracorporeal membrane oxygenation (ECMO) is the provision of long‐term support for severe, potentially reversible cardiopulmonary failure through the use of extrathoracic cannulation and an extracorporeal circuit. The extracorporeal circuit is a modification of the heart‐lung machine used in cardiac bypass surgery and consists of a drainage reservoir, blood pump, artificial lung for oxygen and carbon dioxide exchange, a heat exchanger for maintenance of body temperature, cannulae for vascular access, and connecting tubing. ECMO is used in the management of severe, acute, potentially reversible cardiopulmonary failure in neonates, children, and adults. The modes of support include venoarterial (VA), venovenous (VV), arteriovenous (AV), and hybrid VA and VV (VVA). Venoarterial support bypasses the heart and lungs and provides cardiac and pulmonary support. Venovenous provides gas exchange in the central venous circulation, and it provides pulmonary support only. Arteriovenous is performed using an artificial lung without a pump, but provides carbon dioxide removal only. VVA mode combines partial cardiac support in addition to pulmonary support. The performance of the ECMO circuit depends on several factors. Blood flow is dependent on geometry of the vascular cannulae, tubing, and artificial lung, and it includes laminar and turbulent flow. Pressure‐flow relationships for ECMO circuit components have been published. Gas exchange efficiency in venovenous ECMO is affected by recirculation. The determinants of artificial lung gas transfer are complex but based on principles of passive diffusion. Modern cross‐flow hollow fiber devices that have blood flow exterior to the fibers demonstrate the best blood flow and gas transfer performance.

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Extracorporeal membrane oxygenation for pediatric cardiopulmonary failure

Cited by 53 publications

References 8 publications

Preoperative palliation of newborn obstructed total anomalous pulmonary venous connection by endovascular stent placement

Preoperative palliation of newborn obstructed total anomalous pulmonary venous connection by endovascular stent placement

Surgical Aspects of Pediatric Cardiac Extracorporeal Membrane Oxygenation

Extracorporeal Membrane Oxygenation

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