NEONATAL VA ECMO & VV ECMO (MHFV Internal)

 

Indication for VA ECMO

 

  • Congenital Diaphragmatic Hernia (CDH)
  • Meconium Aspiration Syndrome (MAS)
  • Persistent Pulmonary Hypertension (PPHN)
  • Sepsis
  • Procedural Support with preplanned end point

Inclusion Criteria

  • Condition needs to have a potential for a reversible etiology
  • Inadequate tissue oxygen delivery despite maximal therapy
  • Severe hypoxic respiratory failure with acute decompensation:
    • Oxygenation Index (OI)=20 (consider)
    • Oxygenation Index (OI)=40 (indicated)
  • Severe PPHN

Exclusion Criteria

  • Lethal Chromosomal disorders (trisomy 13, 18, etc.)
  • Severe brain damage
  • Uncontrollable bleeding
  • Significant IVH (grade 3 or greater)
  • Vessel size too small for cannulation (less than 2 kg)
  • Irreversible organ damage (unless can be considered for organ transplant)
  • Less than 34 weeks (due to risk for IVH)

Decision VA or VV:

  • If only respiratory compromise with no cardiac anomaly: VV
  • More than 2 pressors: VA
  • Discussion of cannulation strategy with General Surgeon can determine VV or VA as well

Consult ECMO: 

  • Order Surgical consult: indication ECMO
  • Page General surgery
  • Once agreement on cannulation ACTIVATE NICU ECMO