Extracorporeal membrane oxygenation

Other specialized appHcations of cardiac arrest devices include extracorporeal membrane oxygenation (ECMO) which occurs when the lungs of a premature infant caimot function properly. The market segments for cardiopulmonary support devices are potentially significant. 

Extracorporeal circulation Extracorporeal membrane oxygenation Fat embolism Heat stroke... 

Hart L, Cobaugh D, Sean B, et al. 1991. Successful use of extracorporeal membrane oxygenation ecmo in the treatment of refractory respiratory failure secondary to hydrocarbon. Vet Hum Toxicol 33(4) 361. 

Children-The recommended dose in pediatric patients is for a total daily dose of 2 to 4 mg/kg, to be divided and administered every 6 to 8 hours up to a maximum of 50 mg given every 6 to 8 hours. Limited data in neonatal patients (under 1 month of age) receiving extracorporeal-membrane oxygenation (ECMO) have shown that a dose of 2 mg/kg is usually sufficient to increase gastric pH to greater than 4 for at least 15 hours. Therefore, consider doses of 2 mg/kg given every 12 to 24 hours or as a continuous infusion. 

Serum samples and autopsy specimens were examined from two infants with congenital diaphragmatic hernia who had received life support with extracorporeal membrane oxygenation (ECMO). The serum levels of di(2-ethylhexyl) phthalate after 14 and 24 days of ECMO support were 26.8 and 33.5 mg/L respectively, and levels of 3.5, 1.0 and 0.4 mg/kg di(2-ethylhexyl) phthalate were found in liver, heart and testicular tissues, respectively, and trace quantities were found in the brain. The rate of di(2-ethylhexyl) phthalate extraction from the model PVC circuits was linear with time (rate, 3.5 and 4.1 mg/L per hour). The exposure to di(2-ethylhexyl) phthalate for a 4-kg infant on ECMO support for 3-10 days was estimated to be 42-140 mg/kg (Shneider et al., 1989). 

The toxicity of di(2-ethylhexyl) phthalate was evaluated in 28 term infants with respiratory failure, 18 of whom received extracorporeal membrane oxygenation (ECMO) and were compared with 10 untreated infants. Various clinical parameters of liver, pulmonary and cardiac dysfunction were found to be unaffected in treated infants, even though the rate of administration ranged up to 2 mg/kg bw di(2-ethylhexyl) phthalate over 3-10 days (mean peak plasma concentration, 8 pg/mL). ECMO is considered to be the clinical intervention that results in the highest intravenous dose of di(2-ethylhexyl) phthalate (Karle et al., 1997). 

Shneider, B., Schena, J., Traog, R., Jacobson, M. Kevy, S. (1989) Exposure to di(2-ethylhexyl)phthalate in infants receiving extracorporeal membrane oxygenation (Letter to the Editor). New Engl. J. Med., 320, 1563... 

All of the above-mentioned blood oxygenators are used outside the body, and hence are referred to as extracorporeal oxygenators. They are mainly used for heart surgery, which can last for up to several hours. However, blood oxygenators are occasionally used extracorporeally to assist the pulmonary function of the patients in acute respiratory failure (ARF) for extended periods of up to a few weeks. This use of extracorporeal oxygenators is known as extracorporeal membrane oxygenation (ECMO). 

Exposures of neonatal children to DEHP can be especially high as a result of some medical procedures. For example, upper-bound doses of DEHP have been estimated to be as high as 2.5 mg/kg/day during total parenteral nutrition (TPN) administration and 14 mg/kg/day during extracorporeal membrane oxygenation (ECMO) procedures. 

KarleVA, Short BL, Martin GR, etal. 1997. Extracorporeal membrane oxygenation exposes infants to the plasticizer, di(2-cthylhexyl)phthalatc. Crit Care Med25 696-703. 

Shneider B, Cronin J, Van Marter L, et al. 1991. A prospective analysis of cholestasis in infants supported with extracorporeal membrane oxygenation. JPediatr Gastroenterol Nutr 13 285-289. 

In children, capsaicin spray was demonstrated to cause a severe bronchospasm and pulmonary edema (Winograd, 1977 Bdlmire et al, 1996). In the Billmire study, a 4-week-old infant was exposed to 5% pepper spray after discharge from a self-defense device. The infant suffered respiratory failure and hypoxemia, requiring immediate extracorporeal membrane oxygenation. Inhaled capsaicin causes an immediate increase in airway resistance (Fuller, 1991). This dose-dependent bronchoconstriction after capsaicin inhalation in humans is the same as that demonstrated in asthmatics and smokers (Fuller et al, 1985). The capsaicin-induced bronchoconstriction and release of substance P is due to stimulation of nonmyelinated afferent C-fibers. 

Billmire, D., Vinocur, C., Ginda, M. (1996). Pepper spray induced respiratory failure treated with extracorporeal membrane oxygenation. Pediatrics 98 961-3. 

A randomized, controlled study has shown an enhanced diuretic response to furosemide in infants taking theophylline during extracorporeal membrane oxygenation (49). The underlying mechanism was uncertain, but may have been an increase in glomerular filtration rate. 

Lochan SR, Adeniyi-Jones S, Assadi FK, Frey BM, Marcus S, Baumgart S. Coadministration of theophylline enhances diuretic response to furosemide in infants during extracorporeal membrane oxygenation a randomized controlled pilot study. J Pediatr 1998 133(l) 86-9. 

Life-threatening adult respiratory distress syndrome after intravascular radiographic contrast injection is rare. It has been successfully managed by extracorporeal membrane oxygenation (73). 

Figure 9 Degree of platelet retention in unheparinized rabbits undergoing simulated extracorporeal membrane oxygenation (ECMO) whose extracorporeal blood conduits are lined with MAHMA/NO-containing PVC to inhibit platelet adhesion ( ) as compared with controls whose tubing is made of undiazeniumdiolated PVC ( ). [Adapted from Reference 13 with permission.]...

MunteanW. 1999. Coagulation and anticoagulation in extracorporeal membrane oxygenation.. Irlif Organs 23 979-83... 

Durward A, Guerguerian AM, Lefebvre M, Shemie SD. Massive dilti-azem overdose treated with extracorporeal membrane oxygenation. Pe-diatr Crit Care Med 2003 4 372-376. 

Recently, treatment options for RDS have advanced significantly. Effective drug therapies include surfactant and perfluorocarbons (PECs). Nitric oxide and extracorporeal membrane oxygenation (ECMO) have been used as final resorts. Supportive therapies such as mechanical ventilation, management of acidosis, and diuresis are also important. An algorithm for prevention and treatment of neonatal RDS is presented in Fig. 28-2. 

In pediatric patients with ARDS, extracorporeal membrane oxygenation (ECMO) has been used." These patients have been part of larger cohorts identified as respiratory failure. Anecdotally, practitioners observe the greatest benefit in the sickest patients. Prospective studies are needed to confirm clinical impression. The benefits of ECMO for adults with ARDS seem less optimistic." ... 

Cardiopulmonary bypass—The use of extracorporeal devices to pump blood and oxygenate the blood while the heart or lungs are not functional. Extracorporeal membrane oxygenation (ECMO) is a form of long-term cardiopulmonary b5 pass that is typically used for days to weeks. 

Flamant C, Hallelel F, Nolent P et al (2005) Severe respiratory syncytial virus bronchiolitis in children from short mechanical ventilation to extracorporeal membrane oxygenation. Eur J Pediatr 164 93-98... 

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