1/9. pulmonary embolism and myocardial hypoxia during extracorporeal membrane oxygenation.The treatment of a newborn with severe meconium aspiration by venoarterial extracorporeal membrane oxygenation (ECMO) was complicated by myocardial hypoxia with a marked decrease of myocardial contractility. The onset of the cardiac hypoxia was related to a pulmonary artery embolus. The origin of the embolus was a deep femoral vein thrombosis, caused by a central vein catheter, which was inserted 1 day before ECMO by venous cutdown. The possible pathophysiology of myocardial hypoxia in this patient is discussed, especially with regard to myocardial perfusion, supporting the hypothesis of coronary perfusion occuring with blood from the left ventricle and not from the arterial cannula in the aorta.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/9. Beat-to-beat changes in stroke volume precede the general circulatory effects of mechanical ventilation: a case report.BACKGROUND: The haemodynamic as well as the ventilatory consequences of mechanical ventilation can be harmful in critically ill neonates. Newly developed ventilatory lung protective strategies are not always available immediately and in an acute situation the haemodynamic changes caused by mechanical ventilation can affect the oxygen delivery considerably. We report the case of a male neonate who was treated with conventional pressure-controlled mechanical ventilation because of respiratory distress and progressive respiratory acidosis resulting from meconium aspiration. Because of poor arterial oxygenation despite 100% inspired oxygen and increased ventilator settings, echocardiography was performed to exclude central haemodynamic reasons for low oxygen delivery. METHOD: Doppler echocardiography was used for the measurement of stroke volume and cardiac output. pulse oximetry and aortic blood pressure were monitored continuously. RESULTS: echocardiography revealed no cardiac malformations or signs of persistent fetal circulation. When inspiratory pressures and duration were increased, beat-to-beat variation in stroke volume preceded decay in cardiac output. stroke volume variations and oxygen saturation values guided ventilator settings until extracorporal membrane oxygenation could be arranged for. After recovery and discharge 4 weeks later the boy is progressing normally. CONCLUSION: Because oxygen delivery is dependent on both blood flow and arterial oxygen content, measurement of cardiac output as well as left heart oxygen saturation is a useful guide to optimizing oxygen delivery. This case report demonstrates how Doppler echocardiographic monitoring of beat-to-beat changes in stroke volume can be used to detect early negative haemodynamic effects of increased mechanical ventilation settings before cardiac output is affected.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
3/9. Neonatal survival during a 2,500-mile flight.Neonatal respiratory failure, no matter what the cause, may not always respond to standard mechanical ventilation techniques. extracorporeal membrane oxygenation has emerged over the last 15 years as an adjunct to the treatment of these babies with a greater than 80% survival nationwide. Limited resources and personnel costs can be prohibitive, forcing regionalization of extracorporeal membrane oxygenation (ECMO) centers. Geographic distance from a center should not limit its potential application, however. Familiarity with the technique, early application of the modality and the availability of medical air transport, allows for referral and transfer of neonates over great distances with excellent results and outcomes. We present a case of respiratory failure in a neonate transported 2,500 miles for ECMO therapy with an excellent outcome and a rapid return home.- - - - - - - - - - ranking = 0.4keywords = membrane (Clic here for more details about this article) |
4/9. Altered prostaglandin E1 dosage during extracorporeal membrane oxygenation in a newborn with ductal-dependent congenital heart disease.We describe a neonate with ductal-dependent congenital heart disease on extracorporeal membrane oxygenation (ECMO) for persistent pulmonary hypertension, who required markedly high doses of prostaglandin E1 (PGE1) to maintain patency of the ductus arteriosus: The effects of ECMO on the pharmacokinetics of PGE1 are discussed.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
5/9. Severe meconium aspiration syndrome: case report.This is a case report on severe meconium aspiration syndrome (MAS) that resulted in early neonatal death. Antenatal care was provided at a low-cost non-governmental organization (NGO) clinic. First stage of labour lasted for only 2 hours and 45 minutes. There were no foetal heart rate abnormalities that were noted during the first stage of labour. Artificial rupture of membranes was done in second stage of labour. There was no liquor amnii seen but scanty thick old meconium was noted. Delivery was easy. The baby's skin, nails, umbilical cord, placenta and vernix were deeply stained yellow with old meconium. resuscitation included suction through direct laryngoscopy, nasotracheal intubation with pulmonary toilet, as well as administration of 100% oxygen. The condition of the baby did not improve. A diagnosis of severe MAS with hypoxic ischaemic encephalopathy (HIE), persistent pulmonary hypertension (PPH), persistent foetal circulation syndrome (PFCS) and meconium chemical pneumonitis was made. The baby was admitted to the intensive care unit (ICU) for assisted ventilation and critical care. The condition of the baby continued to deteriorate and demise occurred 18 hours after birth. The pathophysiologic processes of intrauterine meconium release, mechanisms of foetal effects and dilemmas in management are discussed.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
6/9. Carotid artery reconstruction following extracorporeal membrane oxygenation.Right hemispheric brain injury has been noted in surviving infants treated with venoarterial extracorporeal membrane oxygenation (ECMO). This phenomenon may be secondary to permanent ligation of the right carotid artery. At our institution, conventional ventilatory therapy failed in five neonates with respiratory insufficiency, and they were treated successfully with ECMO. In four of the five neonates, the right carotid artery was reconstructed at the time of decannulation. At discharge, all newborns with carotid artery repair showed no signs of unilateral brain injury and had excellent antegrade flow in the right carotid artery as assessed by both duplex and transcranial Doppler ultrasound scanning. Carotid artery reconstruction after ECMO is a technically simple procedure that may reduce the incidence of right hemispheric brain injury and long-term consequences of marginal cerebral perfusion.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
7/9. An absent right and persistent left superior vena cava in an infant requiring extracorporeal membrane oxygenation therapy.A persistent left superior vena cava (PLSVC) is the most common anomaly of the major veins. However, an absent right superior vena cava and PLSVC is much less common; fewer than 100 cases have been reported in the world literature in patients with situs solitus. This rare variation was encountered in a newborn requiring extracorporeal membrane oxygenation (ECMO) for meconium aspiration and interfered with venous cannulation. The anomaly was not suspected before an unusual cannula position was observed on the chest radiograph, and it was confirmed by bedside venography. Adequate venous cannulation was obtained through the anomalous vessel using a flexible catheter, allowing for an uneventful ECMO course. The epidemiology and embryology of this incidental anomaly are reviewed, and the methods used to circumvent the difficulties it presented in this case are described.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
8/9. Newborn extracorporeal lung assist using a novel double lumen catheter and a heparin-bonded membrane lung.We report the clinical application of a novel double lumen catheter for veno-venous extracorporeal lung assist (ECLA) and the use of a heparin-bonded hollow fiber membrane lung, in the treatment of newborn respiratory failure. The outer lumen of the double lumen catheter was 14 Fr and was used for blood drainage; while the inner 8 Fr catheter was used for blood return. The double lumen catheter was made of spiral wire reinforced polyurethane, with a wall thickness of 0.25 mm. The hollow fiber membrane was made of non-microporous polyolefin, and was not permeable to water or plasma. We used this system to treat a newborn patient with meconium aspiration syndrome. heparin was infused continuously at a rate of 18-25 units/kg/h, equal to 1/3 of the usual amount when a non-heparin bonded ECLA system was used and maintaining the activated clotting time near 120 s. Bleeding from cutdown sites was negligible. Only the right internal jugular vein was sacrificed. The patient was successfully weaned from ECLA and appears normal one year following discharge.- - - - - - - - - - ranking = 1.2keywords = membrane (Clic here for more details about this article) |
9/9. thrombosis of the arterial cannula during extracorporeal membrane oxygenation in a full-term newborn infant.The authors report a rare case of cannula thrombosis during extracorporeal membrane oxygenation (ECMO). A full-term newborn infant was successively placed on single-cannula veno-venous extracorporeal lung support and then on veno-arterial ECMO, because of persistent pulmonary hypertension. At 140 hours of ECMO, the infant displayed general cyanosis except in the right arm. Since asymmetric hypoxemia during ECMO may be related either to cannula malposition or to a tip thrombosis, a chest x-ray after contrast injection into the arterial line of the circuit was performed. It showed an opacification of the whole cannula but for the last distal centimeter, and of the vascular bed extending from the right subclavian artery. Cannula thrombosis was suspected and confirmed by removal of the arterial cannula. Demonstration of cannula thrombosis by opacification of the arterial line of the circuit indicates catheter removal.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |