Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-28T13:52:07.244Z Has data issue: false hasContentIssue false

Extracorporeal Membrane Oxygenation

Published online by Cambridge University Press:  10 March 2009

George Lister
Affiliation:
Yale University School of Medicine

Extract

Extracorporeal membrane oxygenation (ECMO) is a means of diverting a fraction or all of the circulation through a device that permits gas exchange across a permeable membrane. The site of removal and the site of return of blood are dictated primarily by practical considerations based on the volume of flow of blood to be diverted and whether a particular organ is to be bypassed. The prototype of extracorporeal oxygenation is heart-lung bypass, used for various types of cardiac surgery, in which the entire venous return is diverted through an oxygenator (bubble or membrane type) and returned to the aorta. Since the earliest reports of the use of ECMO in neonates, venoarterial bypass has been the preferred route, with blood drained from the right atrium and returned either to the carotid artery or to the femoral artery, although the former seems to have been used most often (2;4;11;12;14;18). In some reports, veno-venous bypass has also been accomplished with removal of blood from the right atrium and return into the umbilical or femoral vein (13;19). Gas exchange across the lung may also continue, although the ventilator rate, tidal volume, or peak inspiratory pressure are usually reduced markedly during the period of extracorporeal oxygenation. Anticoagulation is accomplished with few problems by infusion of heparin sulfate throughout the duration of the procedure. There now have been enough reports in the literature (individual cases or series of patients) to demonstrate that the procedure can be carried out with a minimum of technical difficulties in newborn infants (2;3;4;11;12;18), although the selection of “appropriate” patients reduces the morbidity and technical challenges of the procedure.

Type
Neonatal Disorders of Respiration
Copyright
Copyright © Cambridge University Press 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Andrews, A. F., Nixon, C. A., Cilley, R. E., Roloff, D. W., & Bartlett, R. H.One- to three-year outcome for 14 neonatal survivors of extracorporeal membrane oxygenation. Pediatrics, 1986, 78, 692–98.CrossRefGoogle ScholarPubMed
2.Bartlett, R. H., Andrews, A. F., Toomasian, J. M., et al. Etracorporeal membrane oxygenation (ECMO) for newborn respiratory failure: 45 cases. Surgery, 1982, 92, 425–33.Google Scholar
3.Bartlett, R. H., Dietrich, W. R., Cornell, R. G., Andrews, A. F., Dillon, P. W., & Zwischengerger, J. B.Extracorporeal circulation in neonatal respiratory failure: A prospective randomized study. Pediatrics, 1985, 76, 479–87.CrossRefGoogle ScholarPubMed
4.Bartlett, R. H., Gazzaniga, A. B., Jefferies, R., et al. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Transactions of American Society for Artificial Internal Organs, 1976, 22, 8088.Google ScholarPubMed
5.Bohn, D., Tamura, M., Perrin, D., Barker, G., & Rabinovitch, M.Ventilatory predictors of pulmonary hypoplasia in congenital diaphragmatic hernia, confirmed by morphologic assessment. Journal of Pediatrics, 1987, 111, 423–31.CrossRefGoogle ScholarPubMed
6.Cilley, R. E., Zwischenberger, J. B., Andrews, A. F., Bowerman, R. A., Roloff, D. W., & Bartlett, R. H.Intracranial hemorrhage during extracorporeal membrane oxygenation in neonates. Pediatrics, 1986, 78, 699704.CrossRefGoogle ScholarPubMed
7.Cornish, J. D., Gerstmann, D. R., Clark, R. H., Carter, J. M., Null, D. M. Jr., & DeLemos, R. A.Extracorporeal membrane oxygenation and high-frequency oscillatory ventilation: Potential therapeutic relationships. Critical Care Medicine, 1987, 15, 831–34.CrossRefGoogle ScholarPubMed
8.Dworetz, A. R., Moya, F. R., Sabo, B., & Gross, I.Survival in infants with persistent pulmonary hypertension without extracorporeal membrane oxygenation. Pediatric Research, 1987, 21 (abstr.) 360A.Google Scholar
9.Gattinoni, L., Agostoni, A., Pesenti, A., Pelizzola, A., Rossi, G. P., Langer, M., Vesconi, S., Uziel, L., Fox, U., Longoni, F., Kolobow, T., & Damia, G.Treatment of acute respiratory failure with low frequency positive pressure ventilation and extracorporeal removal of CO2. Lancet, 1980, ii, 292.CrossRefGoogle Scholar
10.Gillis, C. N., Pitt, B. R., Wiedemann, H. P., & Hammond, G. L.Depressed prostaglandin E1 and 5-hydroxytryptamine removal in patients with Adult Respiratory Distress Syndrome. American Review of Respiratory Disease, 1986, 134, 739–44.Google ScholarPubMed
11.Hardesty, R. L., Griffith, B. P., & Debski, R. F.Extracorporeal membrane oxygenation: Successful treatment of persistent fetal circulation following repair of congenital diaphragmatic hernia. Journal of Thoracic Cardiovascular Surgery, 1981, 81, 556.CrossRefGoogle ScholarPubMed
12.Kirkpatrick, B. V., Krummel, T. M., Mueller, D. G., Ormazabal, M. A., Greenfield, L. J., & Salzberg, A. M.Use of extracorporeal membrane oxygenation for respiratory failure in term infants. Pediatrics, 1983, 72, 872–76.CrossRefGoogle ScholarPubMed
13.Klein, M. D., Andrews, A. F., Wesley, J. R., Toomsian, J., Nixon, C., Roloff, D., & Bartlett, R. H.Venovenous perfusion in ECMO for newborn respiratory insufficiency: A clinical comparison with venoarterial perfusion. Annals of Surgery, 1985, 201, 520–26.CrossRefGoogle ScholarPubMed
14.Loe, W. A., Graves, E. D. III., Ochsner, J. L., Falterman, K. W., & Arensman, R. M.Extracorporeal membrane oxygenation for newborn respiratory failure. Journal of Pediatric Surgery, 1985, 20, 684–88.CrossRefGoogle ScholarPubMed
15.Pitt, B. R., Lister, G., & Gillis, C. N. Hemodynamic effects on lung metabolic function. In Ryan, U. S. (ed.), Pulmonary endothelium in health and disease. New York: Marcel Dekker, 1987, 6587.Google Scholar
16.Rabinovitch, M., & Reid, L. M. Quantitative structural analysis of the pulmonary vascular bed in congenital heart defects. In Engle, M. A. (ed.), Cardiovascular clinics: Pediatric cardiovascular disease, Philadelphia, PA: F. A. Davis Company, 1981, 149–69.Google Scholar
17.Schumacher, R. E., Barks, J. D. E., Johnston, M. V., Donn, S. M., Scher, M. S., & Bartlett, R. H.Right-sided brain lesions in infants following unilateral carotid ligation for extracorporeal membrane oxygenation. Pediatric Research, 1987, 21 (abstr.) 375A.Google Scholar
18.Short, B. L., Miller, M. K., & Anderson, K. D.Extracorporeal membrane oxygenation in the management of respiratory failure in the newborn. Clinics in Perinatology, 1987, 14, 737–48.CrossRefGoogle ScholarPubMed
19.White, J. J., Andrews, H. G., Risemberg, H., Mazur, D., & Haller, J. A. Jr.Prolonged respiratory support in newborn infants with a membrane oxygenator. Surgery, 1971, 70, 288–96.Google ScholarPubMed