Neonatal ECMO: An Update Amir M. Khan, MD Associate Professor of Pediatrics UT Houston Medical School Medical Director NICU, Neonatal Transport and Respiratory Care Children’s Memorial Hospital, Houston, TX The speaker has signed a disclosure form and indicated he has no significant financial interest or relationship with the companies or the manufacturer(s) of any commercial product and/or service that will be discussed as part of this presentation. Session Summary During this session the presenter will review the historical trend and current uses of ECMO and changes in approach such as VV versus VA, changes in diagnoses, and change in management while on ECMO. Session Objectives Upon completion of this presentation, the participant will be able to: give a brief history of ECMO; understand common indications of ECMO; understand typical management and outcome on ECMO; evaluate the outcome and utilization data of ECMO; recognize indications for ECMO. References Bartlett, R., Roloff, D., Cornell, R., Andrews, A., Dillon, P. & Zwischenberger, J. (1985). Extracorpeal circulation in neonatal respiratory failure: A prospective randomized study. Pediatrics, 76(4): 479-87. O'Rourke, P., Crone, R., Vacanti, J., Ware, J., Lillehei, C., Parad, R. & Epstein, M. (1989). Extracorpeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: A prospective randomized study. Pediatrics, 84(6): 957-63. UK Collaborative ECMO Trial Group (1996). UK collaborative randomized trial of neonatal extracorpeal membrane oxygenation. Lancet, 348(9020): 75-82. Session Outline See presentation handout on the following pages. A9 FANNP 24TH NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEW A9: NEONATAL ECMO: AN UPDATE Page 1 of 8
8
Embed
Neonatal ECMO : An Update - Florida Association of ... Neonatal ECMO-An Update.pdf · Neonatal ECMO : An Update ... and change in management while on ECMO. Session Objectives ...
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Neonatal ECMO: An Update Amir M. Khan, MD Associate Professor of Pediatrics UT Houston Medical School Medical Director NICU, Neonatal Transport and Respiratory Care Children’s Memorial Hospital, Houston, TX
The speaker has signed a disclosure form and indicated he has no significant financial interest or relationship with the companies or the manufacturer(s) of any commercial product and/or service that will be discussed as part of this presentation.
Session Summary
During this session the presenter will review the historical trend and current uses of ECMO and changes in approach such as VV versus VA, changes in diagnoses, and change in management while on ECMO.
Session Objectives
Upon completion of this presentation, the participant will be able to:
give a brief history of ECMO;
understand common indications of ECMO;
understand typical management and outcome on ECMO;
evaluate the outcome and utilization data of ECMO;
recognize indications for ECMO.
References
Bartlett, R., Roloff, D., Cornell, R., Andrews, A., Dillon, P. & Zwischenberger, J. (1985). Extracorpeal circulation in neonatal respiratory failure: A prospective randomized study. Pediatrics, 76(4): 479-87.
O'Rourke, P., Crone, R., Vacanti, J., Ware, J., Lillehei, C., Parad, R. & Epstein, M. (1989). Extracorpeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: A prospective randomized study. Pediatrics, 84(6): 957-63.
UK Collaborative ECMO Trial Group (1996). UK collaborative randomized trial of neonatal extracorpeal membrane oxygenation. Lancet, 348(9020): 75-82.
Session Outline
See presentation handout on the following pages.
A9 FANNP 24TH NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEW
A9: NEONATAL ECMO: AN UPDATE Page 1 of 8
Neonatal ECMOAn Update
Amir M. Khan, MD
INTRODUCTION TO ECMO
What is ECMO?
• A constellation of biomedical devices(heart, lung, kidney, GI tract) compiled to provide life support when biologic organs are failing despite maximal “conventional” care
• A form of extrathoracic partial cardiopulmonary bypass designed as an oxygen delivery system to meet tissue needs
• A system based on a non-porous silicone oxygenator to allow prolonged life support
FANNP 24TH NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEW
A9: NEONATAL ECMO: AN UPDATE Page 2 of 8
ECMO UtilityRandomized Trials
• Bartlett, et al Pediatrics 1985; 76:479-487
• O’Rourke, et al Pediatrics 1989; 84:957-963
• UK Trial Lancet 1996; 348:75-82
Neonatal ECMOUK Trial
ECMO C ti lECMO Conventional
63/93 (68%) 38/92 (41%) p<0.0005
59/75 (79%) 38/75 (51%) p<0.0006)
(No CDH)
Lancet 1996
ELSO
Extracorporeal LifeSupport Organization
Est. 1989Membership Voluntary
Data CollectionStandards
Scientific Exchange
ECMO Circuit
PumpVenous Reservoir
OxygenatorHeat Exchanger
Safety MechanismsCannula
FANNP 24TH NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEW
A9: NEONATAL ECMO: AN UPDATE Page 3 of 8
FANNP 24TH NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEW
A9: NEONATAL ECMO: AN UPDATE Page 4 of 8
When is ECMO needed (generally)?
• When tissue oxygen requirements are not being met by biologic organs and “conventional” care ... usually manifest by progressive metabolic acidosis mixed venousmanifest by progressive metabolic acidosis, mixed venous desaturation (SvO2), and multiple organ failure
• When irreversible biologic organ damage is occurring with conventional care
• When expected mortality likelihood approached 80-90% with conventional care
Indications for ECMO
• Severe Respiratory Failure
• Severe Barotrauma
• Cardiac Failure
Neonatal ECMO
• No lethal anomaly
• No cyanotic heart diseaseNo cyanotic heart disease