pediatrics
Respiratory Support in Neonates and Infants
ECMO for Neonates and Infants
ECMO is a form of cardiopulmonary bypass used for infants with respiratory failure who cannot be oxygenated adequately or ventilated with conventional or oscillating ventilators. Eligibility criteria vary by center, but in general, infants should have reversible disease (eg, Persistent Pulmonary Hypertension of the Newborn , ), blood is circulated through large-diameter catheters from the internal jugular vein into a membrane oxygenator, which serves as an artificial lung to remove CO2 and add oxygen. Oxygenated blood is then circulated back to the internal jugular vein (venovenous ECMO) or to the carotid artery (venoarterial ECMO). Venoarterial ECMO is used when both circulatory support and ventilatory support are needed (eg, in overwhelming Neonatal Sepsis ). Flow rates can be adjusted to obtain desired oxygen saturation and blood pressure. ECMO is contraindicated in infants<34 weeks,<2 kg, or both because of the risk of intraventricular hemorrhage with systemic heparinization. Complications of ECMO include thromboembolism, air embolization, neurologic (eg, stroke, seizures) and hematologic (eg, hemolysis, neutropenia, thrombocytopenia) problems, and cholestatic jaundice. 