Extracorporeal Membrane Oxygenation ( ECMO) is a modified pulmonary or cardiopulmonary bypass technique used to support patients with severe cardiac or respiratory failure (or both) unresponsive to conventional ventilatory support and medical treatment.
INDICATIONS: Meconium Aspiration
Congenital diaphragmatic hernia
Pulmonary hypertension
ECMO involves bypass of venous blood to an external membrane oxygenator before reintroduction either to an arterial circulation, providing heart and lung support or to the venous circulation, providing only lung support.( See the figure )
TYPES OF ECMO;
Venovenous ECMO
Venoarterial ECMO
Heparinization of ECMO will result in cerebral hemorrhage and Pre-ECMO head ultrasound is done and all patients with greater than grade I are excluded.
Daily or weekly head ultrasounds are done to rule out any bleeding complication.
Widening of the interhemispheric fissure is seen in up to 59% of cases and resolves once ECMO is discontinued.
Thoracic and other complications:
Air collections, pleural effusion and hemorrhage.
Adrenal hemorrhage
Hepatic infarction
Intraperitoneal hemorrhage
Splenomegaly
Periosteal reaction
Take Home Message:Patietns on ECMO need close monitoring for brain hemorrhage by sereial head ultrasounds.