Questions about ECMO

prmenrs, RN · Mar 23, 2002

Did you post this under Neonatal, too? If not, you should.

We have not done ECMO in a long time, but from what I remember:

#1 reason to go on ECMO is Meconium Aspiration Syndrome, and the Persistant Fetal Circulation that goes with it. These are term baby issues.

I think that there are limits for gestational age and wt. Under 35 wks, babies are more prone to have Intraventricular Hemorrhages anyway, and they must be heparinized for ECMO, so being a premie is sort of contraindication.

Length of time on ECMO varies upon the baby's progess and condition.

I don't know survival rates and outcome, but I would assume that the kid took a pretty significant hit before ECMO, and may not be Harvard material after--not that that is bad, mind you. I believe they get follow-up in Developmental Clinic to watch for problems, and referral to OT/PT/Speech as needed.

I don't know if quality of PNC (or lack) predicts ECMO. There are criteria for ECMO. Don't know the specifics.

Complications: infection, clotting, hemorrhage, not being able to get off, therapeutic misadventures, i.e., problems w/tubing, machines, etc.; these are VERY unstable babies--death is definitely a possibility.

They put the cannula/ae in the neck.

Hope this helps--and if there is anything I either left out or got wrong, someone will post after me and fix it!! Thanks

Squirrel · Mar 24, 2002

prmenrs:

Thank you very much for your help! Your answers were the ones that I was looking for. And thanks for the tip about posting this to the neonatal icu forum, I just posted it there also.

Thanks again!!!!!!!

babynurselsa, RN · Mar 24, 2002

As prmenrse said, Premies are not candidates for ECMO. Some other instances where it will be usefull is diaphramatic hernias and some cardiac defects, along with MAS and PPHN.

Infants who are septic, or already have IVH are not candidates, these are also parameters for removing babies from ECMO.

In a sense you can say that lack of prenatal care may be a precipitating facor due to these babies beibng at higher risk for things like MAS, either due to post dates or drug exposure.

Usually every other measure is attempted and ECMO is last ditch, babies have failed oscillaor and/or nitric oxide.

Squirrel · Mar 24, 2002

babynurselsa:

Thank you very much! I had the impression that premature infants were the ones most likely placed on ECMO because of the lack of lung development, and I did not realize they were at risk for intraventricular hemmorrhage. So it is mostly indicated for term infants who suffer various conditions that prohibit normal oxygenation, and MAS being the most common.

Once again thank you very much prmenrs and babynurse lsa!

prmenrs, RN · Mar 25, 2002

Squirrel--I checked w/ one of the attendings today about criteria for going on; she told me that the deciding value is the Oxygen Index, which is the Mean Airway pressure x the FiO2 divided by the PaO2. If the OI is>35 [or >65 if baby is on a sensormedics ventilator], that is the critical value for ECMO.

Some places use it post-op, but the better cardiac surgeons believe that if they need ECMO, they should go back to surgery instead.

The baby must have a TREATABLE condition, i.e., no chromosonal issues, or an inoperable heart lesion. They get a head echo 1st, and cannot have a head bleed. The lowest weight they can do is 2 kilos. (I had remembered 2500, wrong)

They baby is very snowed for this proceedure, and are VERY crabby customers afterward. They sometimes have a hard time just learning to eat, but I think they improve as they recover.

You're welcome, happy to help.