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Extracorporeal Membrane Oxygenation

Published online by Cambridge University Press:  10 March 2009

George Lister
George Lister
Affiliation:
Yale University School of Medicine
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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
Information
International Journal of Technology Assessment in Health Care , Volume 7 , Supplement S1 , January 1991 , pp. 52 - 55
Copyright
Copyright © Cambridge University Press 1991

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References

REFERENCES

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