Extracorporeal Life Support Organization (ELSO): Guidelines for Neonatal Respiratory Failure

Wild, K. Taylor; Rintoul, Natalie E.; Kattan, Javier; Gray, Brian W.

doi:10.1097/mat.0000000000001153

Cited by 78 publications

(85 citation statements)

References 21 publications

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“…ECMO may be offered to neonates with severe cardiac and/or respiratory failure, refractory to maximal conventional management, potentially reversible etiology, and high mortality risk [20][21][22][23]. ECMO criteria, as well as contraindications, are reported in Table 2 [22,24].…”

Section: Ecmo Criteria In Neonatesmentioning

confidence: 99%

“…When the cannulas are placed at the neck (either surgical or percutaneously), the position is generally checked with chest X-ray or transthoracic echocardiography [21,22,[87][88][89]. When ECMO is connected to the patient, the pump flow should be started slowly at 20 ml/kg/min and increased gradually over 5 to 10 min in order to achieve adequate oxygen delivery.…”

Section: Ecmo For Neonatal Cardiac Failurementioning

confidence: 99%

“…SpreO 2 is a proxy of tissue oxygenation status, as it reflects the ratio of oxygen delivery to oxygen consumption [22]. Ventilator settings should be tailored at "rest settings" to reduce the risk of VILI, although specific guidelines have not been defined [21,22]. Serial lung mechanics measurements, such as the forced oscillation technique, may be used to titrate ventilatory support and chest physiotherapy, and support either lung recruitment maneuver and pharmacological treatment [91].…”

Section: Ecmo For Neonatal Cardiac Failurementioning

confidence: 99%

“…Fluid management during ECMO is crucial to limit fluid overload and edema [21]. Diuretics, slow continuous ultrafiltration, and continuous renal replacement therapy may be used to achieve dry weight [20,22,93].…”

Section: Ecmo For Neonatal Cardiac Failurementioning

confidence: 99%

“…Thus, other groups successfully promoted trial-off with a retrograde pump flow of the ECMO circuit [142]. If trial-off is tolerated, the patient is ready for decannulation [21,22]. The carotid artery's repair is rarely performed and is still a matter of debate [22,143].…”

Section: Weaning Decannulation and Withdrawalmentioning

confidence: 99%

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Neonatal respiratory and cardiac ECMO in Europe

et al. 2021

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Neonatal extracorporeal membrane oxygenation (ECMO) is a life-saving procedure for critically ill neonates suffering from a potentially reversible disease, causing severe cardiac and/or respiratory failure and refractory to maximal conventional management. Since the 1970s, technology, management, and clinical applications of neonatal ECMO have changed. Pulmonary diseases still represent the principal neonatal diagnosis, with an overall 74% survival rate, and up to one-third of cases are due to congenital diaphragmatic hernia. The overall survival rate in cardiac ECMO is lower, with congenital heart defect representing the main indication. This review provides an overview of the available evidence in the field of neonatal ECMO. We will address the changing epidemiology, basic principles, technologic advances in circuitry, and monitoring, and deliver a current multidisciplinary management framework, focusing on ECMO applications, complications, and long-term morbidities. Lastly, areas for further research will be highlighted. Conclusions : ECMO is a life support with a potential impact on long-term patients’ outcomes. In the next years, advances in knowledge, technology, and expertise may push neonatal ECMO boundaries towards more premature and increasingly complex infants, with the final aim to reduce the burden of ECMO-related complications and improve overall patients’ outcomes. What is Known: • ECMO is a life-saving option in newborns with refractory respiratory and/or cardiac failure. • The multidisciplinary ECMO management is challenging and may expose neonates to complications with an impact on long-term outcomes. What is New: • Advances in technology and biomaterials will improve neonatal ECMO management and, eventually, the long-term outcome of these complex patients. • Experimental models of artificial placenta and womb technology are under investigation and may provide clinical translation and future research opportunities.

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Section: Ecmo Criteria In Neonatesmentioning

confidence: 99%

Section: Ecmo For Neonatal Cardiac Failurementioning

confidence: 99%

Section: Ecmo For Neonatal Cardiac Failurementioning

confidence: 99%

Section: Ecmo For Neonatal Cardiac Failurementioning

confidence: 99%

Section: Weaning Decannulation and Withdrawalmentioning

confidence: 99%

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Neonatal respiratory and cardiac ECMO in Europe

et al. 2021

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Ecmo

Biscotti

Goldshore

Cannon

2022

Surgical Critical Care and Emergency Surgery

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Percutaneous, ultrasound‐guided single‐ and multisite cannulation for veno‐venous extracorporeal membrane oxygenation in neonates

Kipfmueller

Schmitt

et al. 2023

Pediatric Pulmonology

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AimsExtracorporeal membrane oxygenation (ECMO) is a widely used technique to support neonates with severe respiratory failure. Data on percutaneous, ultrasound‐guided veno‐venous (VV) ECMO cannulation in neonates is still scarce. Aim of this study was to describe our institutional experience with ultrasound‐guided percutaneous, VV ECMO cannulation in neonates with severe respiratory failure.MethodsNeonates receiving ECMO support at our department between January 2017 and January 2021 were retrospectively identified. Patients receiving VV ECMO cannulation performed by the percutaneous Seldinger technique by single‐ or multisite cannulation were analyzed.ResultsA total of 54 neonates received ECMO cannulation performed by the percutaneous Seldinger technique. In 39 patients (72%) a 13 French bicaval dual‐lumen cannula was inserted and in 15 patients (28%) two single‐lumen cannulae were used. Cannulae positioning using the multisite approach was in all cases as desired. The tip of the 13 French cannula was located in the IVC in 35/39 patients, in four patients position was too proximal but did not dislocate during the ECMO run. One (2%) preterm neonate (weight 1.75 kg) developed a cardiac tamponade which was successfully managed with drainage. Median duration of ECMO was 7 days (interquartile range: 5–16 days). Forty‐four patients (82%) were successfully weaned from ECMO and in 31/44 (71%) the ECMO cannulae were removed with a delay of 0.9–7.2 days (median 2.8 days) after weaning without noticing complications.ConclusionsA correct cannula placement using the ultrasound‐guided percutaneous Seldinger technique, for both single‐ and multisite cannulation, seems feasible in most neonatal patients receiving VV ECMO.

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Extracorporeal Life Support Organization (ELSO): Guidelines for Neonatal Respiratory Failure

Cited by 78 publications

References 21 publications

Neonatal respiratory and cardiac ECMO in Europe

Neonatal respiratory and cardiac ECMO in Europe

Ecmo

Percutaneous, ultrasound‐guided single‐ and multisite cannulation for veno‐venous extracorporeal membrane oxygenation in neonates

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