Using smaller cannulas for minimally invasive surgery or aggressive cardiopulmonary bypass circuitry miniaturization have increased the need to augment venous drainage to achieve adequate flow rates. This is achieved through vacuum-assisted venous drainage (VAVD) which has been associated with a number of side effects, including:
In 1975, interest in ECMO was re-ignited after Dr. Robert H. Bartlett, then working at the University of California at Irvine, reported his first neonatal ECMO survivor. The baby‘s mother—a poor, illiterate woman from Baja, Mexico—crossed the border and headed for Los Angeles, determined that her child would have a better life as a U.S. citizen. En route, she went into labor and was taken to Orange County Medical Centre where her daughter was born. During delivery, the child had aspirated a large quantity of meconium and developed chemical pneumonitis. Even with maximal ventilatory support, the baby was unable to sustain adequate oxygenation.
A little over a half-century ago, the nation was transfixed by a struggle to save the life of Patrick Bouvier Kennedy, the infant son of President John F. and Jacqueline Bouvier Kennedy. Patrick, 5½ weeks premature and weighing only 4 pounds 10½ ounces, was delivered on Aug. 7, 1963. After birth, he immediately began having trouble breathing and was transferred from Cape Cod to Boston Children’s Hospital where he was placed in a hyperbaric chamber. He died 39 hours later of hyaline membrane disease, which was then the most common cause of death among premature infants (25,000 per year) in the United States.1 The disease is now known as infant respiratory distress syndrome (IRDS). In those days, there were no neonatal intensive care units (NICU), and ventilators had yet to be used for premature babies.
Ultrasound dilution technology is a synthesis of two widely accepted technologies: differential transit-time ultrasound and classic indicator dilution technology.
ECMO is the use of prolonged cardiopulmonary bypass to treat severe respiratory failure in newborns, children and adults. The basic principle is to pump some of the patient’s own blood through an artificial membrane or hollow fiber oxygenator to rest the lungs and give them a chance to heal. ECMO is considered a highly invasive, high-risk therapy. It is used only when there is a high mortality risk with conventional therapies (drugs, mechanical ventilation).