Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy

Abstract

The authors have used prolonged extracorporeal membrane oxygenation (ECMO) in the treatment of thirteen moribund infants (including nine neonates), with four survivors (three neonates). Successfully treated cases include postoperative cardiac failure, infant respiratory distress syndrome, massive meconium aspiration, and persistent fetal circulation. All cases have been managed with venoarterial bypass at flow rates of 80-100 cc/kg/min. Carotid cannulation for arterial access and careful control of heparin anticoagulation based on whole blood activated clotting time are among the techniques which have contributed to this success. Progressive pulmonary or cardiac failure has been the major problem in older infants, intracranial bleeding is the major problem in neonates. Both of these problems could be minimized by instituting ECMO earlier in the clinical course, but this awaits development of reliable early predictors of mortality.