1887
Volume 2017, Issue 1
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

Abstract

For neonates, veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support is still commonly used for respiratory as well as for cardiac or combined failure. However, in the pediatric population, veno-venous (VV) ECMO is establishing itself as the standard mode of support for respiratory failure.1

The need for ECMO in neonatal respiratory support has declined over the past years following introduction of alternative options. Conversely, a significant increase in VA ECMO for cardiac support has been identified (see Figure 1). The present article aims to describe the various indications for VA ECMO in the neonatal population.

Although the majority of cardiac runs for neonates still relates to congenital heart defects, widening experience and indications, such as myocarditis, sepsis, poisoning (reversible), or extracorporeal cardiopulmonary resuscitation (ECPR), have led to an increased use of VA ECMO in neonates and children.

For congenital heart defects, special considerations must be made, especially for ECMO in the context of single ventricle (SV) physiology:3 the balancing between pulmonary and systemic circulation remains crucial whether a Blalock–Taussig shunt or a Sano shunt is used. For the second and third stages of single ventricular palliation, cannulation strategies must be adapted to the underlying anatomy on a case-to-case basis.

Myocarditis due to various reasons can be supported successfully with VA ECMO, which constitutes the ultimate endpoint of the myocarditis management algorithm. Timely deployment before irreversible multi-organ damage has occurred is crucial. Further attention must be paid that myocardium can be quite stunned and left ventricular decompression is mandatory to allow adequate myocardial recovery.4

Sepsis has become an indication if conventional management fails,5 as reflected in the algorithm published by the Surviving Sepsis Campaign in 2012, which recommends starting ECMO in refractory shock.

Case reports with successful support of heart and lung function until recovery for various poisonings or during cath lab interventions have been published.6

ECPR with the deployment of extracorporeal life support (ECLS) during resuscitation has been mentioned in the PALS guideline since 2010 as class II recommendation. As could be expected, outcomes for survival and neurological deficits are related to centers’ experience and resuscitation time prior to ECLS installment.7

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2017.swacelso.34
2017-02-14
2019-10-16
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2017/1/qmj.2017.swacelso.34.html?itemId=/content/journals/10.5339/qmj.2017.swacelso.34&mimeType=html&fmt=ahah

References

  1. [1]. MacLaren   G., , Dodge-Khatami   A., , Dalton   HJ., , Writing Committee., , MacLaren   G., , Dodge-Khatami   A., , Dalton   HJ., , Adachi   I., , Almodovar   M., , Annich   G., , Bartlett   R., , Bronicki   R., , Brown   K., , Butt   W., , Cooper   D., , Demuth   M., , D'Udekem   Y., , Fraser   C., , Guerguerian   AM., , Heard   M., , Horton   S., , Ichord   R., , Jaquiss   R., , Laussen   P., , Lequier   L., , Lou   S., , Marino   B., , McMullan   M., , Ogino   M., , Peek   G., , Pretre   R., , Rodefeld   M., , Schmidt   A., , Schwartz   S., , Shekerdemian   L., , Shime   N., , Sivarajan   B., , Stiller   B., , Thiagarajan   R. . Joint statement on mechanical circulatory support in children: A consensus review from the Pediatric Cardiac Intensive Care Society and Extracorporeal Life Support Organization. . Pediatr Crit Care Med.   2013; ;14: 5 Suppl 1 : S1– S2 .
    [Google Scholar]
  2. [2]. ELSO . ECLS Registry Report – International Summary . July 2016; ;   Ann Arbor, MI, USA: : Extracorporeal Life Support Organization; .
    [Google Scholar]
  3. [3]. Thiagarajan   RR. . Extracorporeal membrane oxygenation for cardiac indications in children. . Pediatr Crit Care Med.   2016; ;17: 8 Sul 1: S155– S159 .
    [Google Scholar]
  4. [4]. Rajagopal   SK., , Almond   CS., , Laussen   PC., , Rycus   PT., , Wypij   D., , Thiagarajan   RR. . Extracorporeal membrane oxygenation for the support of infants, children, and young adults with acute myocarditis: A review of the Extracorporeal Life Support Organization registry. . Crit Care Med.   2010; ;38: 2 : 382– 387 .
    [Google Scholar]
  5. [5]. Maclaren   G., , Butt   W. . Extracorporeal membrane oxygenation and sepsis. . Crit Care Resusc.   2007; ;9: 1 : 76– 80 .
    [Google Scholar]
  6. [6]. Zampi   JD., , Rocchini   A., , Hirsch-Romano   JC. . Elective ECMO support for pulmonary artery stent placement in a 4.9-kg shunt-dependent patient. . World J Pediatr Congenit Heart Surg.   2015; ;6: 1 : 101– 104 .
    [Google Scholar]
  7. [7]. Kane   DA., , Thiagarajan   RR., , Wypij   D., , Scheurer   MA., , Fynn-Thompson   F., , Emani   S., , del Nido   PJ., , Betit   P., , Laussen   PC. . Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. . Circulation.   2010; ;122: 11 Suppl : S241– S248 .
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2017.swacelso.34
Loading
/content/journals/10.5339/qmj.2017.swacelso.34
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): indications and VA-ECMO ECLS
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error