[Clinical application of extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure]

ECMO is a therapeutic alternative for newborns with respiratory insufficiency unmanageable by artificial ventilation. A modified heart-lung machine well suited for long-term application is used both to support life and to take over organ function, allowing this organ to rest and to recover. The ECMO-technique as practised in our group is equivalent to the venous-arterial bypass initiated by the Bartlett-team. Venous blood is drained from the right atrium via the right internal jugular vein. After passage through a membrane oxygenator and a heat exchanger it is returned in an arterialized state to the ascending aorta via the right carotid artery. Cannulation is followed by systemic heparinization. With a roller pump extracorporeal circulation is installed for 3-6 days with flow-rates of 80-120 ml/kg/min. The operation is performed under local anesthesia in the neonatal intensive care unit. The typical course of ECMO is stabilization for the first 24-48 hours on high bypass flow rates keeping paO2 at 50-60 mmHg with minimal ventilator settings (Pmax 20 mmHg. FiO2 0.3-0.4). Bypass flow rates can be reduced for the next 24 h and the patient is taken off and decanulated while on similar ventilator settings. Because of systemic heparinization intracranial bleeding is the main complication for a newborn child on ECMO. The incidence is about 10%. Premature infants per se have a high risk of major intracranial bleeding without ECMO. Therefore contraindications are infants under 35-weeks gestation, and a hemorrhage diagnosed by ultrasound prior to ECMO. Prediction of mortality is estimated by the alveoloarterial oxygen gradient (D [Aa] O2).(ABSTRACT TRUNCATED AT 250 WORDS)