Topics Discussed: extracorporeal membrane oxygenation; pulmonology and respiratory medicine.
Excerpt:"Introduction. Extracorporeal membrane oxygenation (ECMO) is a mechanical means of providing oxygen (O2) delivery and carbon dioxide (CO2) removal for patients who have cardiac and/or respiratory failure. It is accomplished by draining blood from the right atrium with the aid of a roller or centrifugal blood pump that propels blood through an oxygenator where gas exchange occurs. From there it is warmed in a heat exchanger and then transfused back to the patient into the aorta (venoarterial [VA]) or into the right atrium (venovenous [VV]) (Figures 131 and 132). Uniform guidelines have been established to describe essential equipment, procedures, personnel, and training required for neonatal ECMO.
Indications. ECMO is used primarily for critically ill term and late preterm newborns with reversible respiratory and/or cardiac failure who have failed appropriate maximal medical management with ventilator support (conventional and/or high frequency), inhaled nitric oxide, volume expansion, as well as vasopressor and inotropic support. Neonatal conditions treated using ECMO support include meconium aspiration syndrome, congenital diaphragmatic hernia, persistent pulmonary hypertension of the newborn, respiratory distress syndrome, sepsis, pneumonia, and cardiac failure due to cardiomyopathies or severe rhythm disturbances. ECMO can also be used as a bridge to cardiac surgery or transplantation and after open heart surgery.
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