Extracorporeal life support for neonatal cardiorespiratory failure
Prem Puri in Newborn Surgery, 2017
Extracorporeal membrane oxygenation (ECMO) is a life-saving technology that temporarily replaces the function of the heart and lungs. It is a supportive modality rather than a therapeutic tool that provides gas exchange and mechanical hemodynamic support for neonates with an acute, reversible respiratory or cardiac condition. This support spares the infant from the deleterious effects of high Fi02, high airway pressure, traumatic mechanical ventilation, and perfusion impairment. ECMO was first used in newborns in 1974. Since then, the Extracorporeal Life Support Organization (ELSO) has recorded approximately 36,000 newborns that have been supported with ECMO for a variety of cardiorespiratory disorders. The most common disorders in the newborn treated with ECMO are meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the neonate (PPHN), congenital diaphragmatic hernia (CDH), sepsis, and cardiac support. Depending on the indication for ECMO, the outcome is varied, but overall, a cumulative survival rate of over 80% has been reported for newborns (reported to the ELSO registry since its inception) treated for respiratory failure.1 This chapter will discuss the selection criteria for ECMO in neonates and the management of these babies while on ECMO. It will then discuss ECMO for use in difficult clinical scenarios, such as CDH, and finally review outcome and follow-up of neonates treated with ECMO.
Critical care, neurology and analgesia
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
Extracorporeal membrane oxygenation (ECMO) is a complex life support technique for severe pulmonary or cardiopulmonary failure, developed through modification of the heart lung bypass machine [1]. The technique of ECMO involves oxygenating blood outside the body and, thus, obviates the need for gas exchange in the lungs. The technique is categorised as either veno-venous (VV) or veno-arterial (VA), depending on the type of cannulation. In VV ECMO, deoxygenated blood is drained and oxygenated blood re-infused via venous sites. In neonates, this is achieved by placing a double lumen cannula in the right internal jugular vein (Figure 1). In VA ECMO, deoxygenated blood drawn from the right internal jugular vein is returned oxygenated via the right common carotid artery. While VV ECMO provides support purely with gas exchange, VA ECMO also supports the heart.
The Chest
Kenneth D Boffard in Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
The pulmonary contusion is an entity in development. The initial chest x-ray will not show the complete full-blown contusion in the stable patient; CT scan is the modality of choice. The contusion will very often be accompanied by a flail chest. The contusion is a complex of intra-parenchymal bleeding, oedema, and alveolar collapse owing to reduced surfactant production. This leads to ventilation–perfusion mismatch, shunting, and decreased compliance. Treatment consists of a ventilation strategy where one should realize that the ventilation stressors are primarily exerted on the healthier lung. Low volume, high PEEP, permissive hypercapnia, and maintaining a minimum oxygen saturation in order to avoid high oxygen concentrations, may be needed. If oxygenation to the required level is not achieved, extracorporeal membrane oxygenation (ECMO) can be considered, to bridge the time needed to reduce swelling and blood in the alveoli (see also Section 17.3).
Heart of lymphoma: a case report
Published in Acta Cardiologica, 2023
Annemie Jacobs, Thomas Gevaert, Wim Volders, Dieter De Cleen, Katrien Van Kolen, Frank Cools, Steven Hellemans
The current standard of treatment of a mediastinal DLBCL is rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). When there is septal involvement by DLBCL, complete heart block can be seen [8]. Given the risk of myocardial rupture during the chemotherapy treatment, close monitoring is necessary. Furthermore, DLBCL tumours localised to the heart can also be treated with radiotherapy [5]. Utility of surgery or extracorporeal membrane oxygenation (ECMO) in this patient population can address immediate hemodynamic instability but is high risk and not standard or care. Surgical resection is only possible at early stages of disease. Furthermore, surgery can also be palliative to help correct hemodynamics and improve blood flow to the lungs in the case of right ventricle outflow obstruction [1]. In this case, treatment options were discussed with the patient and his family members, and comfort care was preferred.
Lung detection and severity prediction of pneumonia patients based on COVID-19 DET-PRE network
Published in Expert Review of Medical Devices, 2022
Jiaqiao Zhang, Yan Yan, Hongjun Ni, Zhonghua Ni
In areas where nucleic acid testing reagents are scarce, the chest X-ray examination is an effective method for diagnosing COVID-19 pneumonia. Doctors can judge whether a patient is infected with COVID-19 pneumonia based on the transparency of the ground glass shadow in the X-rays. In addition, the doctors also need to determine the severity of the patient’s condition in time to formulate a treatment plan. For example, patients with mild illness only need to self-isolate and take antiviral drugs to enhance their own immunity. While patients with severe illness need the treatment of professional doctors, and even need to be provided oxygen by using extracorporeal membrane oxygenation (ECMO) machines. At present, clinicians mainly judge the severity of patients based on their symptoms and the transparency of the ground glass shadow in the X-rays [3–5]. However, patients with COVID-19 pneumonia have an incubation period, and there are a large number of asymptomatic infections, and some of the symptoms are similar to other diseases. Therefore, directly determining the severity of COVID-19 pneumonia patients based on the superficial symptoms often leads to misdiagnosis. Secondly, it is difficult to distinguish between the ground glass shadow in the X-rays and the surrounding normal lung tissue. When a doctor makes subjective judgments based on his own experience, it is not easy to accurately classify the severity of the disease.
Factors among patients receiving prone positioning for the acute respiratory distress syndrome found useful for predicting mortality in the intensive care unit
Published in Baylor University Medical Center Proceedings, 2018
Ariel M. Modrykamien, Yahya Daoud
Twenty-seven (63%) patients died during the course of the ICU admission. Two of these patients transitioned from prone positioning to extracorporeal membrane oxygenation (ECMO) therapy prior to expiration. No ICU survivor from prone positioning required ECMO treatment. Survivors and nonsurvivors are compared in terms of demographic and clinical information (Table 1) and in terms of mechanical ventilation parameters during the first 4 days of prone positioning (Table 2). As APACHE II, plateau, and ΔP were significant predictors of ICU survival in the univariate analysis, ROC curves were constructed to assess their ability to predict ICU mortality (Figure 1). Furthermore, cut-off points in each ROC curve representing values with the higher possible combination of sensitivity and specificity for prediction of ICU mortality were evaluated (Table 3).
Related Knowledge Centers
- Extracorporeal
- Perfusion
- Pneumonia
- Cardiopulmonary Bypass
- Lung
- Heart
- Respiratory System
- Membrane Oxygenator
- Red Blood Cell
- Covid-19