Reconsidering ECMO in Premature Neonates

Wild, K. Taylor; Hedrick, Holly L.; Rintoul, Natalie E.

doi:10.1159/000509243

Cited by 5 publications

(2 citation statements)

References 22 publications

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“…14 Over the past two decades, severe neonatal CDH has been an indication for ECMO internationally, with survival rates around 50%, which is lower compared to other diseases treated with ECMO. 5,15,16 According In this case, the patient, diagnosed with a right-sided diaphragmatic hernia (involving herniated liver and intestines), was identi ed at 24 weeks of gestation with a LHR of 1.24 and an O/E LHR of 80%. Following a multidisciplinary consultation at our hospital at 27 weeks gestation, a plan was made for delivery at 40 weeks.…”

Section: Case Presentationmentioning

confidence: 99%

Combined extracorporeal membrane oxygenation support and patent ductus arteriosus ligation following surgical correction for congenital diaphragmatic hernia, a case report and literature review

Hong,

Zheng,

Zheng

et al. 2024

Preprint

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Background: Therapeutic measures regarding combined extracorporeal membrane oxygenation support and arterial ductus arteriosus ligation after surgical correction of congenital diaphragmatic hernia are rare in clinical practice. Case presentation: In this case, the patient was diagnosed at 24 weeks with a right-sided diaphragmatic hernia. He was the firstborn, delivered at 37 weeks via cesarean section due to fetal distress. Due to severe hypoxemia and pulmonary hypertension, the patient underwent right-sided thoracic diaphragmatic hernia repair surgery at 22 hours post-birth. Perioperatively, the patient exhibited severe respiratory and circulatory failure. Consequently, ECMO support was initiated one hour after the surgery (24 hours post-birth). Due to the high left to right shunt, bedside patent arterial duct ligation was successfully performed under ECMO support four hours later (28 hours post-birth). During the second day on ECMO, the patient developed intracranial hemorrhage, leading to the performance of a lateral ventriculostomy. Fortunately, the patient was successfully weaned off ECMO. Conclusions: Treatment strategies for CDH must be tailored to each patient’s unique clinical situation, encompassing aspects such as ventilation tactics, surgical timing, anesthesia choices, and surgical techniques. The detailed analysis of this case in this report illustrates the critical importance of tailoring CDH management to optimize patient prognosis.

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Section: Case Presentationmentioning

confidence: 99%

Combined extracorporeal membrane oxygenation support and patent ductus arteriosus ligation following surgical correction for congenital diaphragmatic hernia, a case report and literature review

Hong,

Zheng,

Zheng

et al. 2024

Preprint

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“…Veno-arterial (V-A) ECMO still represents the support of choice in neonates, with more than 80% receiving V-A support ( 2 ). The vessel size is the most critical limiting factor in using the veno-venous (V-V) ECMO in neonates as the smallest double-lumen venous cannula currently commercially available is 13 Fr ( 3 , 7 ). However, it should be noted that mortality is not significantly different between the two types of support.…”

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confidence: 99%

Editorial: Neonatal ECMO in 2019: Where Are We Now? Where Next?

et al. 2022

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Editorial on the Research TopicNeonatal ECMO in 2019: Where Are We Now? Where Next? Despite significant advances in neonatal intensive care, including neonatal ventilation in the current era, extracorporeal membrane oxygenation (ECMO) continues to play a crucial role in selected cases of severe cardio-respiratory failure, potentially reversible, but refractory to conventional ventilatory therapy and maximal pharmacological treatment (1).Our Research Topic attempted to focus on some of continuing challenges in neonatal ECMO. In this issue of Frontiers in Pediatrics, we have collected a wide range of manuscripts related to the use of ECMO in the neonatal period (Broman; Butt and Chiletti; Cashen et al.; Di Nardo et al.; Kersten et al.; Macchini et al.; Perez Ortiz et al.; Rafat and Schaible; Raffaeli et al.; Raffaeli et al.; Roeleveld and Mendonca; Schiller and Tibboel).Since the formation of the Extracorporeal Life Support Organization (ELSO) in 1989, 45,205 newborns have been supported on ECMO in 492 centers (www.elso.org) (2). Respiratory failure was the predominant reason for ECMO utilization in 33,400 newborns, whereas ECMO was used for cardiac failure in 9,561 newborns, and 2,244 were supported for refractory cardiac arrest-extracorporeal cardiopulmonary resuscitation (ECPR). Today, congenital diaphragmatic hernia (CDH) and meconium aspiration syndrome (MAS) are the exclusive neonatal diagnoses that alone represent about 46% of all cases of neonatal respiratory ECMO, reaching 92% of total ECMO if all "others" neonatal ECMO were added (2, 3). The classification of "others" includes all other diagnostic categories such as non-specific respiratory failure, congenital anomaly, pulmonary hypoplasia, hypoxic-ischemic encephalopathy, cardiorespiratory arrest, and inborn errors of metabolism (4). The mortality rate, however, varies significantly depending on the underlying respiratory disease. For instance, neonates with CDH and sepsis have higher mortality rates (47 and 49%, respectively) in contrast to those with MAS (9%) (2). Pulmonary hypertension and lung hypoplasia play a crucial role in determining survival in CDH (5). Neonates with prolonged ECMO run for >21 days have demonstrated higher mortality due to the increased risk of mechanical complications (6).Veno-arterial (V-A) ECMO still represents the support of choice in neonates, with more than 80% receiving V-A support (2). The vessel size is the most critical limiting factor in using the veno-venous (V-V) ECMO in neonates as the smallest double-lumen venous cannula currently commercially available is 13 Fr (3, 7). However, it should be noted that mortality is not significantly different between the two types of support. However, neurological complications are reported to be

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ECMO for the Neonate

Alibrahim

Heard

2023

Neonatal Anesthesia

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Reconsidering ECMO in Premature Neonates

Cited by 5 publications

References 22 publications

Combined extracorporeal membrane oxygenation support and patent ductus arteriosus ligation following surgical correction for congenital diaphragmatic hernia, a case report and literature review

Combined extracorporeal membrane oxygenation support and patent ductus arteriosus ligation following surgical correction for congenital diaphragmatic hernia, a case report and literature review

Editorial: Neonatal ECMO in 2019: Where Are We Now? Where Next?

ECMO for the Neonate

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