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Extracorporeal membrane oxygenation for respiratory and cardiac failure in infants and children
Insights
Extracorporeal membrane oxygenation (ECMO) effectively treated neonates with acute respiratory failure (90% survival). While outcomes varied for congenital heart disease and diaphragmatic hernia, ECMO showed promise for high-risk pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Neonatology
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital life support technology.
- Assessing ECMO efficacy in neonates and pediatric patients is crucial for refining treatment protocols.
Purpose of the Study:
- To evaluate the outcomes of ECMO in a cohort of neonates and pediatric patients.
- To determine the effectiveness of ECMO in treating acute respiratory and cardiac failure in young patients.
Main Methods:
- Venoarterial bypass was established using right internal jugular vein to right atrium and right common carotid artery to aortic arch cannulation.
- Fifty-three neonates and seven pediatric patients underwent ECMO treatment between September 1983 and April 1986.
Main Results:
- Neonates with acute respiratory failure had a 90% survival rate (36/40).
- Survival rates for neonates with congenital heart disease and congenital diaphragmatic hernia were 60% (3/5) and 38% (3/8), respectively.
- In pediatric patients, ECMO support for post-cardiac surgery ventricular failure or acute respiratory failure yielded one long-term survivor and one survivor, respectively.
Conclusions:
- ECMO is effective in salvaging high-risk neonates with acute respiratory failure, demonstrating low morbidity and mortality.
- ECMO serves as a valuable support modality for neonates with congenital heart disease and congenital diaphragmatic hernia.
- While pediatric ECMO outcomes may not match neonatal results, it offers a life-saving option for critically ill children with cardiorespiratory failure.
Abstract:
Fifty-three neonates and seven pediatric patients were treated with extracorporeal membrane oxygenation from September 1983 until April 1986. Venoarterial bypass was achieved by cannulating the right atrium via the right internal jugular vein and the aortic arch via the right common carotid artery. In the neonatal group, 40 infants with acute respiratory failure were treated, and 36 (90%) survived. Five infants with congenital heart disease were treated and three (60%) survived. Among the eight patients with congenital diaphragmatic hernia, there were three (38%) survivors. In the pediatric group, four patients were treated for ventricular failure after cardiac operations. Two were weaned from bypass, with one long-term survivor. Three patients with acute respiratory failure were treated, with one survivor. salvaging high-risk neonates with minimal morbidity and mortality. It has also been useful in the support of infants with congenital heart disease and congenital diaphragmatic hernia. In pediatric patients one cannot expect to get results that are comparable to those found in neonates. Still, this modality can be useful in salvaging some moribund patients with pulmonary or cardiac failure, or both.