1 - Extracorporeal Life Support Organisation of the South and West Asia Chapter 2017 Conference Proceedings
  • ISSN: 0253-8253
  • EISSN: 2227-0426


Strategy during extracorporeal membrane oxygenation (ECMO) support is guided by available outcome data. Boundaries limiting selection of cases are shifting with advances in ECMO technology, conventional support, and destination therapies. Neonatal respiratory ECMO numbers continue to decline due to improved conventional therapies, whereas infants historically excluded from ECMO (for example, ex-premature infants with O-dependent chronic lung disease and severe RSV) are now successfully supported. ECMO for bridging of children to lung transplant is now established.1 Advances are also being made in mobile ECMO,2 long duration of ECMO support, and ECMO while wide awake. Flow requirements and patient or vessel size govern cannula choice. Percutaneous cannulation of vessels with ultrasound guidance is described in all sizes of children, including small infants.3 Serial imaging and ECHO control are needed for optimisation of cannula position and orientation. Transoesophageal ECHO is preferable to transthoracic where available. Reconfiguration of the circuit may prove necessary in some cases and is better done early in the run.4 Protocol and bundle adherence are the keys to preventing complications. Detection requires vigilance and rigorous checks along with comprehensive handover and tight teamwork. Management is about appropriate escalation and pathway utilisation. Simulation is an essential component of staff training and a powerful tool for reinforcing these points.5 ECMO can be considered the ultimate in “lung rest” techniques. Enhancing lung recovery during the rest provided by ECMO is mainly achieved by attention to fluid balance, pulmonary toilet, and adoption of ventilator rest settings. Bronchoscopy is also particularly useful in this context.6 Other therapies such as prone position, steroid use, surfactant, perfluorocarbon,7 and even individual lung ventilation2 have a role in selected cases. Patience can be needed when timing the end to VV ECMO support. Removing the sweep gas from the oxygenator can be done simply without having to wean ECMO flow. In more difficult situations, 12–24 h trial off can be used. Radiological lung clearance, improving lung compliance, reduction of sweep gas requirements, and oxygen challenges are all informative in the run up to a decision to trial off. Lung biopsy8 or genetic test results are useful when recovery is absent to help establish futility. Earlier de-cannulation can be indicated in the setting of an intractable or severe complication. Strategy for management of VV ECMO support is evolving with improvements in ECMO techniques and advances in supporting therapies. A proactive, rigorous but flexible approach to individual cases can deliver excellence.


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  1. Schmid FA, Inci I, Bürgi U, Hillinger S, Schneiter D, Opitz I, Huber LC, Isenring BD, Jungraithmayr W, Schuurmans MM, Weder W, Benden C. Favourable outcome of children and adolescents undergoing lung transplantation at a European adult center in the new era. Pediatr Pulmonol. 2016; 51:11:12221228.
    [Google Scholar]
  2. Brown K, Brown K, Dunne B, Festa M, La Hei E, Karpelowsky J, Dando H, Orr Y. Successful 2,000-kilometer international transfer of an infant receiving extracorporeal membrane oxygenation for severe respiratory failure. Ann Thorac Surg. 2016; 102:2:e131e133.
    [Google Scholar]
  3. Moscatelli A, Buratti S, Gregoretti C, Lampugnani E, Salvati P, Marasini M, Ribera E, Fulcheri E, Tuo P. Emergency percutaneous, bicaval double-lumen, ECMO cannulation in neonates and infants: Insights from three consecutive cases. Int J Artif Organs. 2015; 38:9:517521.
    [Google Scholar]
  4. Werner NL, Coughlin M, Cooley E, Haft JW, Hirschl RB, Bartlett RH, Mychaliska GB. The University of Michigan experience with veno-venoarterial hybrid mode of extracorporeal membrane oxygenation. ASAIO J. 2016; 62:5:578583.
    [Google Scholar]
  5. Johnston L, Oldenburg G. Simulation for neonatal extracorporeal membrane oxygenation teams. Semin Perinatol. 2016; 40:7:421429.
    [Google Scholar]
  6. Kamat PP, Popler J, Davis J, Leong T, Piland SC, Simon D, Harsch A, Teague WG, Fortenberry JD. Use of flexible bronchoscopy in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support. Pediatr Pulmonol. 2011; 46:11:11081113.
    [Google Scholar]
  7. Mychaliska G, Bryner B, Dechert R, Kreutzman J, Becker M, Hirschl R. Safety and efficacy of perflubron-induced lung growth in neonates with congenital diaphragmatic hernia: Results of a prospective randomized trial. J Pediatr Surg. 2015 July; 50:7:10831087.
    [Google Scholar]
  8. Lohmann P, Lee TC, Kearney DL, Fernandes CJ. Pre-cannulation lung biopsy shortens ECMO course. Pediatr Surg Int. 2016; 32:7:713716.
    [Google Scholar]
  • Article Type: Research Article
Keyword(s): ECMOlung restneonatalpediatric and respiratory
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