A modified circuit and priming procedure for neonatal ECMO

Abstract

Advances in extracorporeal membrane oxygenation (ECMO) technology and equipment have allowed improvements in technique which simplify the pro cedure and increase its safety. We describe modifications to our neonatal ECMO circuit which permit use of a low priming volume (500 ml) and allow the circuit to be used in a transport setting. Major changes include the elimination of the priming reservoir, the addition of prebypass and arterial inline filters, the use of a small portable pump, and battery power backup of all components. The priming procedure has been substantially changed and its four phases are described in detail. As neonatal ECMO becomes more widely utilised, further refinements in equipment, procedure and technique can be anticipated.

Get full access to this article

View all access options for this article.

References

Bartlett RH , Gazzaniga AB Extracorporeal circulation for cardiopulmonary failure. Current Problems in Surgery 1978; 25: 1.

German JC , Worcester C. , Gazzaniga AB et al. Technical aspects in the management of the meconium aspiration syndrome with extracorporeal circulation. J Pediatr Surg 1980; 15: 378.

Hardesty RL , Griffith BP , Debski RF , Jeffries MR , Borovetz HS Extracorporeal membrane oxygenation. Successful treatment of persistent fetal circulation following repair of congenital diaphragmatic hernia. J Thorac Cardiovasc Surg 1981; 81: 556.

Bartlett RH , Gazzaniga AB Physiology and pathophysiology of extracorporeal circulation. In Ionescu MI , Wooler GH eds, Current techniques in extracorporeal circulation . London: Butterworths, 1981.

Extracorporeal membrane oxygenation technical specialists manual, seventh edition. University of Michigan Department of Surgery, 1984: 22-24.

Cornish JD , Gerstmann DR , Begnaud MJ , Null DM Jr , Ackerman NB Inflight use of extracorporeal membrane oxygenation for severe neonatal respiratory failure. Perfusion 1986;1: 281-87.

Brans YW , Cornish JD , Kuehl TJ , Dutton EB , Andrew DS , Menchaca EM Effect of extracorporeal membrane oxygenation on body water content and distribution of baboon neonates. Pediatr Res 1986; 20: 381.

Cornish JD , Gerstmann DR , Null DM Jr , Smith MD , Kuehl TJ Relationship of pump flow and hemoglobin saturation to indicators of sufficiency of oxygenation during extracorporeal membrane oxygenation in the newborn baboon . Pediatr Res 1987; 21: 199A.

Cornish JD , Gerstmann DR , Clark RH , Carter JM , Null DM Jr , de Lemos RA Extracorporeal membrane oxygenation and high frequency oscillatory ventilation: potential therapeutic benefits. Crit Care Med (in press).