Neonatal extra corporeal membrane oxygenation
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REVIEW ARTICLE
Neonatal extra corporeal membrane oxygenation Suneel Kumar Pooboni 1 Received: 20 April 2020 / Revised: 27 June 2020 / Accepted: 30 June 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Extracorporeal life support (ECLS) has been proven to be very useful in the neonatal period. For reversible respiratory and cardiac disorders, when maximal conventional measures have failed to provide life support, extracorporeal membrane oxygenation (ECMO) becomes the treatment of choice. The indications, contra-indications for ECMO, optimization of the care prior to embracing ECMO, cannulation techniques, daily management of ECMO from the practical standpoint, weaning and decannulation, complications, and special circumstances in neonatal period have been described. The follow-up of neonatal ECMO and various system manifestations necessitating careful review will be highlighted. Keywords Neonatal ECMO . ECLS . Cannulation . Monitoring . Follow-up
Introduction When maximal conventional support fails in rescuing sick neonates, extracorporeal membrane oxygenation (ECMO) will be the option in treating reversible respiratory and cardiac pathologies. ECMO in the neonatal period was done for the first time by Dr. Robert Bartlett in the year 1975. Since 1989, 32,385 neonates required ECMO for respiratory causes, 8830 neonates were treated for cardiac causes, and 2035 neonates were resuscitated with extracorporeal cardiopulmonary resuscitation (ECPR) as reported to the Extracorporeal Life Support Organization (ELSO) registry (International ELSO Registry, Jan 2020) [1]. Extracorporeal life support has been proved to be very useful in the neonatal period . Interestingly, placental circulation is similar to the ECMO design. Neonatal age group is phenomenal for its plasticity, rapid replication of the tissues, and the influence of hypoxia on developing organs, more so on the brain. The issues range from human anatomy to economics and emotional bonding. Neonatal lung growth continues until 2 years of age and beyond. It will be interesting to note the effect of fibrosis developing within the neonatal lung as a result of baro-trauma and volu-trauma, as a reflection of ventilatorinduced lung injury. As we all know, humans breath and support their respiratory function as negative pressure ventilation.
* Suneel Kumar Pooboni [email protected] 1
Consultant Pediatric Intensivist, Pediatric Critical Care Medicine, Mediclinic Hospital, Dubai, UAE
It makes sense to consider ECMO therapy before causing irreplaceable lung injury for avoiding ventilator-related lung injury, by giving time for the recovery of the injured lung. Neonatal ECMO in premature babies deals with a newborn with increasing fragility, urging us to keep away from them as the tissues could be very porous and immature. They tend not to tolerate high pressures as the cerebral blood vessels could rupture easily. Added to that is the small size of the vasculature making the cannulation process difficult as the available cannulae only permit v
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