Extracorporeal membrane oxygenation life support: a new approach

Area of Science:

• Pediatric critical care medicine
• Cardiopulmonary support technologies

Background:

• Extracorporeal life support (ECLS) is a vital intervention for pediatric patients with acute, life-threatening heart or lung failure.
• Traditional roller pumps have limitations in providing optimal cardiopulmonary support.
• Patient selection for ECLS typically involves those with a grave prognosis (80% chance of death) but who are otherwise expected to recover fully.

Purpose of the Study:

• To evaluate the utility and outcomes of ECLS utilizing a novel constrained vortex pump (CVP) in neonates and children.
• To highlight the advantages of the CVP system, including circuit changeover capability and patient-specific priming.
• To assess the survival rates in a cohort of critically ill pediatric patients receiving ECLS.

Main Methods:

• Implementation of an ECLS circuit featuring a constrained vortex pump (CVP) designed for seamless circuit exchange.
• Circuit priming tailored to match patient biochemistry for improved compatibility and support.
• Retrospective analysis of ECLS utilization in neonates and children at the Royal Children's Hospital, Melbourne, from May 1989.

Main Results:

• ECLS was provided to 30 neonates, with 20 survivors (67% survival rate).
• ECLS was administered to 22 children, with 8 survivors (36% survival rate).
• The CVP system facilitated continuous support during circuit changes and was primed to optimize patient biochemical parameters.

Conclusions:

• ECLS, particularly with advanced systems like the CVP, is an effective life-saving measure for pediatric patients with severe cardiopulmonary compromise.
• The CVP offers potential advantages in terms of operational efficiency and patient-specific management.
• ECLS provides essential support for patients unable to maintain adequate oxygenation, ventilation, or cardiac output.