Extracorporeal membrane oxygenation: Use in meconium aspiration syndrome

Division of Neonatology, Department of Pediatrics, Children's National Medical Center, The George Washington School of Medicine, Washington, DC 20010, USA.
Journal of perinatology: official journal of the California Perinatal Association (Impact Factor: 2.07). 12/2008; 28 Suppl 3:S79-83. DOI: 10.1038/jp.2008.152
Source: PubMed


Extracorporeal membrane oxygenation (ECMO) has been successful as a rescue therapy for infants with respiratory failure with some diagnoses such as meconium aspiration syndrome (MAS) having a survival rate of more than 94%. New therapies have allowed many infants who would have required ECMO to be kept off ECMO, but at what cost. The survival rate for the neonatal ECMO patient has dropped over the years, whereas the time of ECMO has increased, indicating that the new therapies are keeping the less ill infants off ECMO. The major cause of non-survival in this population remains intraventricular hemorrhage. The primary risk factors related to this are thought to be pre-ECMO events, such as hypoxia and/or ischemia either prenatally or post-delivery. ECMO events that may complicate this are heparinization that is required while on ECMO and concern for the effect of shear stress and blood flow pattern changes created by the ECMO pump with venoarterial ECMO, although these changes are not seen in venovenous ECMO, the more common form of ECMO. Newer low-resistant microporous artificial lungs and miniaturized pumping systems may allow ECMO to be performed using less blood and safer equipment. The smaller low-resistant artificial lungs provide the ability to consider giving extracorporeal life support using only this membrane with flow provided by an arterial-venous shunt, thus eliminating the pumping system all together. Trials are ongoing in adults and, if effective, may direct further research into using this technique in newborns where the umbilical artery and vein could be used as the arterial-venous shunt.

Download full-text


Available from: Billie Short, Mar 12, 2014

Click to see the full-text of:

Article: Extracorporeal membrane oxygenation: Use in meconium aspiration syndrome

5.38 MB

See full-text
  • Source
    • "ECMO is now available to infants with MAS in selected centres in 33 countries worldwide [76], albeit at a high cost (at least 2.5 times the daily cost of standard intensive care) [77]. With the advent of newer therapies, the number of infants with MAS treated with ECMO has decreased [78], but survival with ECMO treatment for MAS has remained high (around 95%) [75]. The usual indication for commencing ECMO is intractable hypoxaemia despite optimisation of the patient's condition with available therapies (including high-frequency ventilation and iNO) and bolus surfactant therapy). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Meconium aspiration syndrome (MAS) is a complex respiratory disease of the term and near-term neonate. Inhalation of meconium causes airway obstruction, atelectasis, epithelial injury, surfactant inhibition, and pulmonary hypertension, the chief clinical manifestations of which are hypoxaemia and poor lung compliance. Supplemental oxygen is the mainstay of therapy for MAS, with around one-third of infants requiring intubation and mechanical ventilation. For those ventilated, high ventilator pressures, as well as a relatively long inspiratory time and slow ventilator rate, may be necessary to achieve adequate oxygenation. High-frequency ventilation may offer a benefit in infants with refractory hypoxaemia and/or gas trapping. Inhaled nitric oxide is effective in those with pulmonary hypertension, and other adjunctive therapies, including surfactant administration and lung lavage, should be considered in selected cases. With judicious use of available modes of ventilation and adjunctive therapies, infants with even the most severe MAS can usually be supported through the disease, with an acceptably low risk of short- and long-term morbidities.
    International Journal of Pediatrics 02/2012; 2012:965159. DOI:10.1155/2012/965159
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In a piglet model of meconium aspiration we compared lavage with surfactant with that with perflubron (PFOB) and a control group. A human meconium suspension was instilled into piglets which were randomized in 3 (n = 6 each) groups. After lung injury, the control group was ventilated with high-frequency oscillatory ventilation (HFOV) without suctioning and lavage. A second group was lavaged with 10 ml/kg diluted surfactant, a third with 10 ml/kg pre-oxygenated PFOB. Thereafter, the animals of both groups were ventilated with HFOV. After lung injury by instillation of meconium, no further improvement in oxygenation was possible in animals of the control group and 3 piglets died during the ventilation. The subjects of the surfactant group improved promptly, and at the end of the study the arterial pO(2) was significantly better than immediately after injury as compared with the other groups. Lavage with PFOB had intermediate effects in gas exchange and oxygenation compared to surfactant lavage. No differences were observed in arterial blood pressure and heart rate as well as in histological lung injury score between all groups. Lavage with exogenous surfactant as well as with PFOB improve pulmonary gas exchange in a piglet model of meconium aspiration.
    Biology of the Neonate 02/2002; 81(2):126-31. DOI:10.1159/000047197 · 1.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Extracorporeal life support (ECLS) has become an accepted therapeutic measure in the treatment of infants, children and adults with reversible respiratory or cardiac failure. The principle behind ECLS involves obtaining access to drain blood from the venous circulation into the extracorporeal circuit where it is oxygenated and cleansed of carbon dioxide before being returned to the circulation. The UK Collaborative ECMO Trial showed that an ECLS policy was clinically effective in terms of improved survival without a rise in severe disability at age 1 year. Long-term follow-up has confirmed these benefits. The value of ECLS in paediatric and, more recently, adult respiratory failure is becoming clearer. ECLS has a vital role to play in the support of paediatric cardiac surgery programmes. Recent advances include newer oxygenators, greater use of less invasive veno-venous support and the use of ECLS to support novel therapies used to treat severe congenital diaphragmatic hernia.
    Paediatric respiratory reviews 07/2003; 4(2):147-52. DOI:10.1016/S1526-0542(03)00021-6 · 2.20 Impact Factor
Show more