Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

Macchini, Francesco; Cesare, Antonio Di; Morandi, Anna; Ichino, Martina; Raffaeli, Genny; Conigliaro, Federica; Sorrentino, Gabriele; Neri, Simona; Mosca, Fabio; Leva, Ernesto; Cavallaro, Giacomo

doi:10.3389/fped.2019.00398

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…In addition, team training and expertise plays a major role in favorable ECMO outcome. We expect a survival improvement in the very recent years, which we would like to confirm with additional analysis ( 43 – 45 ).…”

Section: Discussionsupporting

confidence: 58%

NeoAPACHE II. Relationship Between Radiographic Pulmonary Area and Pulmonary Hypertension, Mortality, and Hernia Recurrence in Newborns With CDH

et al. 2021

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Congenital diaphragmatic hernia is a rare disease with high mortality and morbidity due to pulmonary hypoplasia and pulmonary hypertension. The aim of the study is to investigate the relationship between radiographic lung area and systolic pulmonary artery pressure (sPAP) on the first day of life, mortality, and hernia recurrence during the first year of life in infants with a congenital diaphragmatic hernia (CDH). A retrospective data collection was performed on 77 CDH newborns. Echocardiographic sPAP value, deaths, and recurrence cases were recorded. Lung area was calculated by tracing the lung's perimeter, excluding mediastinal structures, and herniated organs, on the preoperative chest X-ray performed within 24 h after birth. Logistic and linear regression analyses were performed. Deceased infants showed lower areas and higher sPAP values. One square centimeter of rising in the total, ipsilateral, and contralateral area was associated with a 22, 43, and 24% reduction in mortality risk. sPAP values showed a decreasing trend after birth, with a maximum of 1.84 mmHg reduction per unitary increment in the ipsilateral area at birth. Recurrence patients showed lower areas, with recurrence risk decreasing by 14 and 29% per unit increment of the total and ipsilateral area. In CDH patients, low lung area at birth reflects impaired lung development and defect size, being associated with increased sPAP values, mortality, and recurrence risk.Clinical Trial Registration: The manuscript is an exploratory secondary analysis of the trial registered at ClinicalTrials.gov with identifier NCT04396028.

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Section: Discussionsupporting

confidence: 58%

NeoAPACHE II. Relationship Between Radiographic Pulmonary Area and Pulmonary Hypertension, Mortality, and Hernia Recurrence in Newborns With CDH

et al. 2021

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“…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%

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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“…Therefore, the VA ECMO was the selected method for most neonates. 10,11 VA ECMO was adopted in all neonates in our center.…”

Section: Discussionmentioning

confidence: 99%

Surgical experience of extracorporeal membrane oxygenation for neonates with severe respiratory failure

Zhang

Chen

Zhou

et al. 2023

Preprint

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Objective Extracorporeal membrane oxygenation (ECMO) has been increasingly used for severe neonatal respiratory failure refractory to conventional treatments. This paper summarized our operation experience of neonatal ECMO via cannulation of the internal jugular vein and carotid artery. Methods The clinical data of 12 neonates with severe respiratory failure who underwent ECMO via internal jugular vein and carotid artery in our hospital from January 2021 to October 2022 were collected. Results All the neonates were successfully operation. The size of arterial intubation was 8 F, the size of venous intubation was 10 F. The operation time was 29 (22–40) minutes. ECMO was successfully removed in 8 neonates. They were successfully reconstructed the internal jugular vein and carotid artery. Arterial blood flow was unobstructed in 5 patients, mild stenosis in 2 patient, moderate stenosis in 1 patient. Venous blood flow was unobstructed in 6 patients, mild stenosis in 1 patient, and moderate stenosis in 1 patient. The complications were as follows: 1 case had poor neck incision healing after ECMO removing. No complications such as incisional bleeding, incisional infection, catheter-related blood infection, cannulation accidentally pulling away, vascular laceration, thrombosis, cerebral hemorrhage, cerebral infarction, and hemolysis occurred in all the patients. Conclusion Cannulation of the internal jugular vein and carotid artery can quickly establish an effective ECMO access for neonates with severe respiratory failure. Careful, skilled and delicate operation was essential. In addition, during the cannulation process, we should pay special attention to the position of cannulation, firm fixation and strict aseptic operation.

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Surgical Expertise in Neonatal Extracorporeal Membrane Oxygenation (ECMO): A Single Center Experience

Cited by 9 publications

References 15 publications

NeoAPACHE II. Relationship Between Radiographic Pulmonary Area and Pulmonary Hypertension, Mortality, and Hernia Recurrence in Newborns With CDH

NeoAPACHE II. Relationship Between Radiographic Pulmonary Area and Pulmonary Hypertension, Mortality, and Hernia Recurrence in Newborns With CDH

Neonatal respiratory and cardiac ECMO in Europe

Surgical experience of extracorporeal membrane oxygenation for neonates with severe respiratory failure

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