Page 602 - Clinical Application of Mechanical Ventilation

568 Chapter 17

Perfluorocarbon (PFC) liquids are the first substances that have been shown to
support respiration and are able to carry more oxygen than a gas. Additionally, PFC
can more easily remove carbon dioxide than a gas (Leach et al., 1996).
Liquid ventilation has potential applications for use in several diseases that tradi-
tionally have been difficult to treat. Included are RDS, aspiration syndromes, persis-
tent pulmonary hypertension of the newborn, and pneumonia (Greenspan, 1993).
While the potential of a favorable impact on the treatment of neonates is nearer,
much research is still necessary before liquid ventilation takes its place among cur-
rent treatment modalities.

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

With patients for whom it is difficult or near impossible to maintain adequate oxy-
genation by conventional means (oxygen therapy, CPAP, PEEP), it may become
necessary to oxygenate the blood outside the body. One method used with moder-
ate success is the procedure of extracorporeal membrane oxygenation (ECMO).
extracorporeal membrane
oxy genation (ECMO): Oxygenation
of blood outside the body through a History
membrane oxygenator.

Oxygenation of blood outside the body, through a membrane oxygenator, was first
developed for use in open-heart surgery in the 1950s. The technology continued
to improve and modifications allowed long-term use of the technique in the 1960s
(Carlo & Chatburn, 1988).
The first use of the extracorporeal membrane oxygenator on an infant was done
and described in 1971 (Zwischenberger et al., 1986). This paved the way for perfec-
tion and refinement of the technique. Today ECMO is used in many institutions
across the country.

Patient Selection

Because of the potential risks associated with ECMO, the clinical criteria used
selects only those infants who are at an 80% or greater risk of mortality if conven-
Candidates for ECMO
include patients with PPHN, tional methods are used.
MAS, sepsis or congenital Patients with severe presentations of the following pathologies may be consid-
diaphragmatic hernia.
ered as candidates for ECMO: persistent pulmonary hypertension of the newborn
(PPHN), meconium aspiration syndrome (MAS), sepsis, or congenital diaphrag-
matic hernia.
Several limitations have been established that help to define the ECMO population.
ECMO is not recommend- Those infants at a gestational age less than 34 weeks or weighing less than 2,000 g are
ed for infants of less than
34 weeks gestational age, excluded from consideration. This is due to the significant mortality associated with
weighing less than 2,000 g, or intracranial hemorrhage (ICH) (Revenis et al., 1992). Any patient with an existing
having evidence of intracranial
hemorrhage (ICH). ICH is not a candidate for ECMO. This is because of the need for systemic hepa-
rinization during the procedure, which could worsen an intracranial bleed. This also
requires that any coagulopathy be corrected before initiating ECMO.

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