Page 605 - Clinical Application of Mechanical Ventilation

Neonatal Mechanical Ventilation 571

Desired
Gas Mixture

Patient
Bridge
Heat
Exchanger

Membrane
Oxygenator

Infusion Sites
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Reservoir
Bladder
Roller Pump
Figure 17-6 A typical ECMO circuit.

level of heparin required for anticoagulation. Intracranial hemorrhage (ICH) has
Bleeding, ICH, pulmonary been reported to affect 14% of ECMO patients in one study (Donn, 1990). The
edema, and hemorrhage are
some potential complications incidence of ICH may be decreased if cephalic jugular venous drainage is used in
of ECMO therapy.
conjunction with ECMO (O’Connor, 1993).
There is also a high incidence of seizures in ECMO patients. It is unknown whether
the seizures are caused by the therapy, the disease, or both (Donn, 1990). Pulmo-
nary edema, the release of vasoactive substances secondary to platelet-membrane
interaction, and pulmonary hemorrhage are potential pulmonary complications.
Cardiovascular complications arise from hypo- and hypervolemia leading to
hypo- and hypertension in the infant. Hypertension is seen in about 7% of ECMO
patients (Donn, 1990). Alteration of the reninangiotensin-aldosterone cycle,
secondary to the nonpulsatile perfusion, may lead to renal complications.
Anemia, leukopenia, and thrombocytopenia are all possible hematologic compli-
cations caused by the consumption of blood components by the membrane oxygen-
ator (Carlo & Chatburn, 1988). Due to the invasive nature of ECMO, there is an
increased risk of infection. Roughly 6% of patients on ECMO have positive blood
cultures (Donn, 1990).
Mechanical complications arise in approximately 10% of ECMO cases and in-
clude failure of the pump, rupture of the tubing, failure of the membrane, and dif-
ficulties with the cannulas (Donn, 1990).

Implications. The initial hope that ECMO could provide a safe means of ventilating the
sick neonate has not been realized. It became apparent early on that there are many haz-
ards and complications that make the procedure suitable in only a few selected clinical
conditions. The long-term complications of ECMO are still unknown. It is necessary
to permanently ligate the carotid artery used to cannulate the patient, and the effects
of having a single carotid artery as the patient grows older have yet to be determined.

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