Extracorporeal membrane oxygenation is the use of extracorporeal circulation and gas exchange to provide temporary life support in patients with reversible cardiac or pulmonary failure.

Indications: Infants with cardiac or pulmonary failure secondary to:

• Congenital Diaphragmatic Hernia

• Persistent Pulmonary Hypertension

• Meconium aspiration

• Sepsis

• Hyaline Membrane Disease

Patient criteria:

• Greater than 34 weeks gestation

• Greater than 2000gm birthweight

• Absence of terminal chromosomal anomalies

• No non-correctable congenital heart disease confirmed by Echo

• No intraventricular hemorrhage greater than grade I

• Absence of profound asphyxia

• Less than 7 days on a ventilator

• Underlying disease capable of resolution in 10 days

• Failure of maximal medical therapy

Infants who meet the above criteria and who have a PaO2 < 50 x 4 hours by arterial blood gas meet final criteria for being placed on ECMO.

If such an infant is deteriorating/not improving or is being transported in for possible ECMO, an ECMO alert is in place.

Notify the nurse coordinator for the ECMO unit, Randy Bartlison, RN (beeper 835-4902.)

Notify the physician coordinator for the NICU ECMO unit, Dr. Bill Walsh (835-0619.)

Notify the pediatric surgeons.

Notify the pediatric cardiologists for a stat Echocardiogram.

Notify the pediatric radiologists for a stat Head Ultrasound.

While the infant is waiting to be placed on ECMO, obtain the following labs:

• Comprehensive Metabolic Profile (1.5 ml in a red top tube)

• Ionized Calcium (0.3 ml in a blood gas syringe)

• CBC with Differential and Platelets (0.5-1 ml in a purple top tube)

• ACT

• PT/PTT and Fibrinogen (2 ml in a blue top tube)

• STAT Basic Metabolic Profile (0.5 ml in a red top bullet-send orange requisition)

• Blood Type and Cross

• Blood culture, if not already done

• Newborn State Screen

References:

Elbourne D, Field D, Mugford. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database of Systematic Reviews.   http://www.nichd.nih.gov/cochrane/Elbourne/Elbourne.htm

UK Collaborative ECMO Trial Group. UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. Lancet 1996; 348: 75-82.

Kanto WP Jr, Bunyapen C. Extracorporeal membrane oxygenation: Controversies in selection of patients and management. Clin Perinatol 1998; 25: 123-35.