SEARCH · PubMed Health

Results for “Extracorporeal membrane oxygenation”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources

PubMed1986

One- to three-year outcome for 14 neonatal survivors of extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation, using venoarterial or venovenous perfusion, is a safe and effective procedure in the term of near-term infant with life-threatening respiratory failure. Without extracorporeal membrane oxygenation, due to the severity of their disease, these children are at high risk for neurologic damage, chronic lung disease, and death. Because survival is not expected without extracorporeal membrane oxygenation therapy, there is no corresponding control group to which these survivors may be compared. In this report, we reviewed the outcome at 1 to 3 years in the first 14 survivors of extracorporeal membrane oxygenation treated at our institution. Seven of 14 neonatal extracorporeal membrane oxygenation survivors (50%) were normal or near normal at between 1 and 3 years of age. Ten (71%) had normal mental ability. We conclude that in neonates with high mortality risk from respiratory failure, near-normal growth and development can be expected in the majority who survive with extracorporeal membrane oxygenation treatment.

Cerebral Hemorrhage↗

PubMed1995

[Persistent pulmonary hypertension in a newborn infant treated with extracorporeal membrane oxygenation].

Extracorporeal membrane oxygenation is a recent addition to our therapeutic arsenal in infants with life-threatening respiratory failure. We have treated a neonate with persistent pulmonary hypertension secondary to meconium aspiration with veno-arterial extracorporeal membrane oxygenation. Both conventional, pressure-controlled ventilation and high-frequency jet ventilation having failed, extracorporeal membrane oxygenation was life-saving for this infant. A clotting episode in the extracorporeal membrane oxygenation circuit resulted in focal as well as global ischemic changes in the brain. In spite of this complication the child was found to be normal upon neurodevelopmental evaluation at one year of age. Extracorporeal membrane oxygenation is a high-technology therapy which should probably be centralized to only one to two units in Norway. It may be life-saving for selected patients who do not respond to other forms of therapy, but the risk of sequelae is not insignificant.

Critical Illness↗

PubMed1997

Clinical antecedents of neurologic and audiologic abnormalities in survivors of neonatal extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation is an effective rescue treatment for severe cardiorespiratory failure in term or near term neonates, although cerebral palsy, mental retardation, and sensorineural hearing loss are observed in 10 to 20% of survivors. The objective of the present study was to identify potential risk factors that may explain the neurologic and audiologic sequelae noted in 19% of 181 survivors of neonatal extracorporeal membrane oxygenation from our hospital. Our results suggest the following findings in survivors of severe cardiorespiratory failure treated with neonatal extracorporeal membrane oxygenation: (1) hypotension or the need for cardiopulmonary resuscitation before extracorporeal membrane oxygenation significantly increases the risk of spastic cerebral palsy, (2) profound hypocarbia before extracorporeal membrane oxygenation is associated with a significantly increased risk of hearing loss, (3) mental retardation in the absence of spastic cerebral palsy is unexplained except when due to abnormal fetal brain development, and (4) hypoxemia in the absence of hypotension does not increase the risk of neurologic or audiologic sequelae.

Brain↗

PubMedDate not supplied

Neonatal and pediatric extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation provides an external circulation for the critically ill patient with components capable of supporting the cardiorespiratory system while the patient's innate organs recover from the primary insult. This therapy is often used in children with relatively well-elucidated indications. Although initially used in the setting of neonatal respiratory failure, the use of extracorporeal membrane oxygenation for pediatric respiratory and cardiac indications is not uncommon. The complications and the outcomes of extracorporeal membrane oxygenation compare favorably with other forms of conventional therapy.

Critical Illness↗

PubMed2001

Neonatal electroencephalogram does not predict cognitive and academic achievement scores at early school age in survivors of neonatal extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation is an effective rescue treatment for severe cardiorespiratory failure in term or near-term neonates, although a wide range of neurologic sequelae have been noted in a substantial minority of survivors. The objective of the present study was to determine the value of the neonatal electroencephalogram (EEG) for predicting Wechler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), Wide Range Achievement Test, and Wide Range Assessment of Memory and Language scores at early school age in 66 testable survivors of extracorporeal membrane oxygenation who were not severely brain damaged. Technically satisfactory EEG recordings were obtained at least twice following admission to our nursery and prior to discharge. The EEGs were classified and graded according to standard criteria. The developmental test results of those who had only normal or mildly abnormal neonatal EEGs (group 1, n = 9) were compared with those who had at least one moderately or markedly abnormal recording (group 2, n = 57). School-age test and subtest scores were not statistically significantly worse in group 2 versus group 1 infants. No child in group 1 and five children in group 2 had WPPSI-R Full-Scale IQ scores of less than 70. Of the nine children in group 2 who had at least one markedly abnormal neonatal EEG recording (graded as burst suppression or as electrographic seizure), only two had abnormally low WPPSI-R Full-Scale IQ scores. We conclude that EEG recordings obtained during the neonatal course of neonates treated with extracorporeal membrane oxygenation do not predict cognitive and academic achievement test results in survivors at early school age who were testable and not severely brain damaged.

Brain Damage, Chronic↗

PubMed1988

Life-threatening intrathoracic complications during treatment with extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) has been successful (greater than 80% survival) in 35 centers in greater than 900 newborns with severe respiratory failure having an estimated mortality of greater than 80% on conventional management. During the last 3 years we have treated 79 newborns with 74 survivors (94%). Their diagnoses included meconium aspiration, persistent fetal circulation, respiratory distress syndrome, congenital diaphragmatic hernia, and sepsis. Seven patients (9%) had life-threatening intrathoracic complications requiring emergent intervention while on ECMO: tension hemothorax (3), tension pneumothorax (2), and pericardial tamponade (2). Pericardial tamponade and tension hemothorax and pneumothorax show a similar pathophysiology of increasing intrapericardial pressure and decreasing venous return. Perfusion is initially maintained by the nonpulsatile flow of the ECMO circuit before further decrease in venous return results in decreasing ECMO flow and progressive hemodynamic deterioration. Each of the seven patients demonstrated a clinical triad that includes increasing PaO2 and decreasing peripheral perfusion (as evidenced by decreasing pulse pressure and decreasing SvO2) followed by decreasing ECMO flow with progressive deterioration. The diagnoses were confirmed by transillumination, chest x-ray, or cardiac echocardiogram. Initial emergent placement of a percutaneous drainage catheter was temporizing in all seven cases. However, four patients required emergent thoracotomy for definitive treatment while still on ECMO. All seven patients were weaned from ECMO and are short-term survivors (6 months to 3.5 years). As use of ECMO for newborn severe respiratory failure increases, responsible physicians must be familiar with life-threatening intrathoracic complications and appropriate treatment strategies.

Cardiac Tamponade↗

PubMed1994

Extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation has now evolved into standard therapy for patients unresponsive to conventional ventilatory and pharmacological support. This article presents a clinical review of extracorporeal life support and its application to neonatal and pediatric patients as well as children requiring circulatory support after open heart surgery.

Cardiac Surgical Procedures↗

PubMed1989

Pharmacokinetics of gentamicin in neonates on extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) has been used in more than 1,000 infants in 50 centers in the United States. The extracorporeal circuit contains approximately 400 ml of blood, an amount exceeding the blood volume of most full-term neonates. The effect of this additional blood volume on drug disposition is unknown. In this study, we determined the pharmacokinetic parameters of gentamicin in 10 infants on ECMO. Gentamicin concentrations were determined by a fluorescence polarization immunoassay. Pharmacokinetic parameters were determined from these concentrations by using a two-compartment model. Our study demonstrated a mean steady-state volume of distribution of 0.51 +/- 0.11 liters/kg, a figure similar to that in previous studies of full-term infants. The elimination half-life was found to be prolonged (mean, 573 +/- 263 min). The creatinine level in the plasma of the infants was found to be a statistically significant predictor of elimination half-life. Recommendations regarding initial dosing levels of gentamicin in infants on ECMO are made.

Blood Urea Nitrogen↗

PubMed1996

Total tracheobronchial thrombosis due to extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is widely used for neonatal respiratory failure that is potentially reversible but unresponsive to conventional management. Because of the anticoagulation necessary for maintaining the extracorporeal circuit, hemorrhagic complications occur in up to one third of patients. We present an unusual and previously unreported complication of ECMO, total tracheobronchial thrombosis. The thrombus filled the entire lower respiratory tract and resulted in airway obstruction and inability to ventilate. The airway was successfully managed with repeated bronchoscopic pulmonary toilet. Our experience and review of the literature provide a summary of ECMO-related complications likely to present to the otolaryngologist, and management strategies are discussed.

Airway Obstruction↗

PubMed2006

[Polytrauma with severe lung contusion. Early use of extracorporeal membrane oxygenation].

Extracorporeal membrane oxygenation (ECMO) is a technique for sustaining body oxygenation in case of respiratory failure. Since ECMO technology has undergone improvements resulting in better hemo-compatibility and reduced side effects, venovenous ECMO is a mostly accepted treatment of adult respiratory distress syndrome (ARDS). One should discuss the early initiation of ECMO therapy for post-traumatic respiratory failure. We report about a 23-year-old male and a 15-year-old female patient, who suffered polytrauma and received early treatment with ECMO because of severe lung contusion.

Accidental Falls↗

PubMedDate not supplied

Complicated cannula insertions and cannula dislodgments associated with extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation therapy remains a life saving modality for neonates with cardiopulmonary disease that is unresponsive to conventional therapy. Vital to its success is the insertion and maintenance of appropriately sized vascular cannulas. Problematic insertion and accidental dislodgments can be life threatening. To determine the treatment and outcome of these complications, a survey of participating Extracorporeal Life Support Organization centers was undertaken. Venous cannulation complications (13 patients) were due to inadequate vein size or tearing during initial attempts at cannulation. Proximal and alternative site cannulation were used. Difficult arterial cannulations (seven patients) were most often due to creation of an intimal flap that was corrected by proximal cannulation of the same vessel. The 10 cases of accidental dislodgment were most often associated with changes in position. Despite copious hemorrhage in many instances, 6 of 10 patients survived with intact neurologic status. Methods for dealing with these life threatening cannula related complications are described.

Cardiovascular Diseases↗

PubMed1987

Lung compliance as a measure of lung function in newborns with respiratory failure requiring extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) can now be used as an alternative mode of therapy for infants 2.0 kg or more with life-threatening respiratory failure. Current criteria for removal from ECMO are limited. We attempted to determine whether lung compliance (CL) could be used as a sensitive indicator of the neonates' lung improvement while they are on ECMO, as well as a predictor of their ability to tolerate removal from bypass. We obtained serial CL measurements in 13 infants, all of whom weaned successfully from ECMO. All had an initial CL on ECMO of 0.5 ml/cm H2O X kg or less (mean = 0.3), with a final CL of 0.8 ml/cm H2O X kg or more (mean = 1.7). The average change in CL from the initial to the final measurement was 0.6 ml/cm H2O X kg or more (mean = 1.5). CL findings correlated well with estimated bypass, expressed as a percent of cardiac output, and a radiographic score of pulmonary abnormality (r = -.66, p less than .0001, and r = -.52, p less than .0001, respectively). We conclude that CL measurements can be used to monitor clinical improvement in infants on ECMO, to predict their successful removal from bypass, and ultimately to shorten their total time spent on bypass.

Cardiac Output↗

PubMedDate not supplied

Neonatal extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation is an effective life support technique that has had most success in the treatment of neonatal cardiopulmonary failure. We review the technique and its potential indications and present the latest UK and worldwide survival data.

Extracorporeal Membrane Oxygenation↗

PubMed1992

Gentamicin pharmacokinetics in term neonates receiving extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) may affect the pharmacokinetics of certain drugs. The objectives of this study were to determine (1) the pharmacokinetics of gentamicin in neonates on ECMO and compare them to reported values for a similar patient population not on ECMO, (2) if the pharmacokinetics of gentamicin differ between venous-venous and venous-arterial bypass, and (3) if the pharmacokinetics of gentamicin are affected by oxygenator surface area (0.6 m2 vs 0.8 m2 oxygenators). The medical records of 29 term neonates who received gentamicin while on ECMO were reviewed. Data collected included gentamicin dosage, peak and trough serum concentrations determined at steady state, duration of treatment, time on ECMO, daily weights, and pertinent laboratory values. An initial dosage of gentamicin 2.5 mg/kg every 18 hours is suggested for term neonates on ECMO. Dosage adjustments should be based on gentamicin serum concentrations, and modifications may also be required after ECMO.

Bacterial Infections↗

PubMed1994

Gas exchange across native lungs and extracorporeal membrane in neonates and pigs during extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is a commonly used treatment modality for severe neonatal respiratory failure. The aim of the present study was to evaluate the relationship between ECMO blood flow and gas exchange across the native lungs and the extracorporeal membrane. In three healthy pigs, the ECMO flow correlated significantly with oxygen transfer (VO2) across the membrane (n = 12, r = .90, P < .001) and inversely with VO2 across the lungs (n = 12, r = -.75, p < .005). In three pigs with acute respiratory distress syndrome induced by repeated bronchoalveolar lavage, flow also significantly correlated with VO2 across the membrane (n = 9, r = .93, P < .001) and inversely with VO2 across the lungs (n = 9, r = -.97, P < .001). Eight neonates had measurements taken at different time intervals and different flow rates during ECMO. The ECMO flow correlated significantly with VO2 across the membrane (n = 45, r = .61, P < .001) and inversely with VO2 across the lungs (n = 15, r = -.54, P < .05). The relationship between carbon dioxide transfer (VCO2) and ECMO flow rates had the same trend as VO2 on all occasions. It is concluded that the ECMO flow rate is one of the main determinants of gas exchange across the lungs and the membrane.

Animals↗

PubMed1994

Continued pulmonary recovery observed after discontinuing extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is a valuable therapy for the treatment of reversible lung disease in neonates. Associated with this treatment, however, are risks for complications that increase with the duration of therapy. We evaluated alveolar-arterial oxygen tension difference P(A-a)O2 pulmonary compliance (CL), and functional residual capacity (FRC) in 20 infants immediately after ECMO was discontinued, and again 24 hours thereafter. We measured CL by pneumotachography and esophageal manometry and FRC by helium dilution. Mean (+/- SEM) values for CL and FRC increased (CL from 0.28 +/- 0.02 to 0.35 +/- 0.03 mL/cmH2O)/kg and FRC from 18.6 +/- 1.4 to 22.2 +/- 1.1 mL/kg; P < 0.05), and P(A-a)O2 and the oxygenation index (OI) decreased (200 +/- 19 to 169 +/- 14 mm Hg and 6.9 +/- 0.44 to 5.4 +/- 0.5, respectively; P < 0.02), over the 24 hour period following ECMO. Nineteen of 20 infants experienced improvement in at least two of these parameters. Improvements were found to be greatest in the infant with the worst lung function immediately after discontinuing ECMO, and in the ten infants who had not received pancuronium bromide for inducing skeletal muscle paralysis, following decannulation from ECMO. These data indicate that improvement in lung function following ECMO will generally continue over the 24 hour period following the termination of cardiopulmonary bypass, and that borderline pulmonary status may not preclude discontinuation of bypass therapy.

Extracorporeal Membrane Oxygenation↗

PubMed2000

The effects of nitric oxide on coagulation during simulated extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is associated with profound alterations in hemostasis, with platelet dysfunction often being implicated as a causative factor for transfusion. Nitric oxide (NO) has shown to be a rapid yet temporary inhibitor of platelet function. The purpose of this study was to evaluate the effects of NO on platelet number and function in an in vitro ECMO model. Eight silicone membrane oxygenators were primed with fresh, heparinized, bovine blood and allowed to circulate for 48 hours. The treatment group (NO) consisted of four oxygenators that had an end concentration of 20 ppm NO applied to the sweep gas. Platelet counts, methemoglobin levels, plasma-free hemoglobin levels, activated clotting times, and thromboelastographic (TEG) studies were performed at baseline, 1, 6, 12, and 24 h. Scanning electron microscopy (SEM) was performed on sample areas from each oxygenator. The treatment group maintained an average of 25% higher platelet counts than the control group (85.1 +/- 32.0, x 10(3) versus 66.5 +/- 30.9 x 10(3)) although statistical significance was not achieved. Methemoglobin levels were significantly elevated in the treatment circuit at hours 12 and 24 (p < .05). This could be attributed to the lack of a biological interaction that would break down this toxic by-product. TEG indices steadily declined in both groups from baseline (-0.4 +/- 3.6) to (-17.2 +/- 3.3 p < .0007) treatment and (-20 +/- 4.5, p < .0001) control, with the treatment circuit maintaining only slightly improved indices over the most of the study. SEM data showed increased fibrin and cellular deposits in the control group (p = .05) when compared with the treatment group. NO added to the sweep gas of a simulated ECMO circuit at 20 ppm had little effect on the maintenance of platelet number and function.

Blood Coagulation↗

PubMed1997

Extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is prolonged cardiopulmonary bypass used to treat critically ill patients with severe but reversible cardiac and/or respiratory failure. The severity of their symptoms, the rapid deterioration in their conditions, the difficulty in mechanical transportation, and the risks of traveling with an ECMO circuit often prohibit cannulation in an operating room. Cannulation for and decannulation after ECMO therapy can be safely accomplished in the intensive care unit by utilizing experienced perioperative nurses.

Adaptation, Psychological↗