Neonatal ECMO

Abstract

ECMO is a technique of providing cardiac & respiratory support to sustain life. Nowadays it is being increasingly used in newborns. Respiratory ECMO is used for severe respiratory distress syndrome, pneumonia & meconium aspiration syndrome. Cardiac ECMO is used after open heart surgery, myocarditis or myopathy. There are two types of ECMO, Veno-Venous (V-V) bypass & Arterio-Venous (A-V) bypass. ECMOcan be used to bridge patients with heart failure as they await heart transplantation & as an adjunct to cardiopulmonary resuscitation. ECMO should be used in reversible diseases only after analysing various factors. Qualifying criteria for ECMO are applied only when the infant has reached maximal ventilatory support. Only babies with gestational Age > 34 weeks, Birth Weight > 2,000 grams, without major coagulopathy, with mechanical ventilation < 14 days & reversible lung disease are eligible for ECMO. Absolute contraindications include Grade 3 or 4 IVH, irreversible brain injury, lethal malformations, non-treatable congenital heart disease & significant coagulopathy. The ECMO circuit consists of a cannula to drain deoxygenated blood from the patient, a pump, an artificial lung to provide oxygenation & ventilation, heat exchanger, a second cannula to return oxygenated blood back to the patient Management during ECMO includes Oxygenation, Inotropic support, Rest Ventilation & Sedation. Complications include Bleeding, Infection, myocardial stun, neurodevelopmental problems, Pneumothorax, pulmonary haemorrhage, bronchial asthma, Sensorineural disabilities,acute tubular necrosis, Feeding difficulty, metabolic derangements, Psychosocial morbidity & Neuromotor deficits .Early initiation of ECMO, monitoring & prompt management of expected complications will improve survivalwithout severe disability.