Pediatric Perfusion, Pediatric ECMO - Mr. Curt Shelley, MEd, RRT-NPS

"Pediatric Perfusion and Pediatric ECMO"

This session provides a comprehensive exploration of Extracorporeal Membrane Oxygenation (ECMO) with a particular focus on pediatric applications. ECMO is a life-saving technology used to provide prolonged cardiac and respiratory support to patients whose heart and lungs are unable to function adequately. This video covers the history, development, and advancements of ECMO, specifically in pediatric settings, highlighting the nuances and considerations essential for successful patient outcomes.

Introduction to ECMO

The session begins with an introduction to ECMO, discussing its history and development. ECMO, which stands for Extracorporeal Membrane Oxygenation, is a sophisticated form of life support that provides cardiac and respiratory assistance. It is often used in critical care settings, particularly for patients experiencing severe cardiac or respiratory failure.

Historical Background

The historical context of ECMO is explored, starting with early discoveries in the 19th century. The session outlines significant milestones:

• 1885: Schroeder discovered that bubbling oxygen through blood turns it bright red, leading to an understanding of blood oxygenation.
• 1916: Dr. McLean discovered heparin, a crucial anticoagulant used in ECMO procedures.
• 1930s: Dr. John Gibbon developed the first heart-lung machine, a precursor to modern ECMO technology.
• 1971: The first adult survivor of prolonged ECMO was recorded.
• 1974: The first neonatal survivor, Esperanza, marked a milestone in pediatric ECMO.

Development and Advancements

Significant advancements in ECMO technology and methodology are discussed, particularly the contributions of Dr. Bartlett at the University of Michigan. The 1980s and 1990s saw an explosion of ECMO centers worldwide, driven by successful trials and improved understanding of ECMO’s benefits over conventional treatments.

ECMO in Pediatric Settings

The session shifts focus to pediatric ECMO, explaining its critical role in treating neonatal and pediatric patients. Key points include:

• Patient Populations: Differences between neonatal, pediatric, and adult ECMO, including the specific needs and challenges of each group.
• Common Indications: Conditions such as congenital diaphragmatic hernia, meconium aspiration syndrome, and persistent pulmonary hypertension of the newborn (PPHN) are highlighted as common reasons for initiating ECMO in neonates and children.

Techniques and Equipment

Detailed explanations of the various techniques and equipment used in pediatric ECMO are provided:

• Cannulation Sites: Discussion on the preferred cannulation sites for pediatric patients, typically involving the jugular vein and carotid artery for effective oxygenation and perfusion.
• Oxygenators: The evolution of oxygenators from early silicone models to modern, more efficient devices is covered, emphasizing the improvements in safety and effectiveness.

Case Studies and Real-Life Applications

The session includes several case studies and real-life applications of ECMO in pediatric settings:

• Prolonged ECMO Support: Examples such as a patient on ECMO for over 13 months while awaiting a lung transplant illustrate the potential for long-term support and successful outcomes.
• Survival Rates: Data from ECMO centers worldwide are presented, showing survival rates and the impact of ECMO on patient outcomes.

Complications and Management

Potential complications associated with ECMO, particularly in pediatric patients, are discussed:

• Anticoagulation Management: The use of heparin and other anticoagulants to prevent clotting while minimizing bleeding risks.
• Cannula-related Issues: Managing complications related to cannulation, such as infections and vascular damage.

Advances in Pediatric ECMO

Recent advances in pediatric ECMO are highlighted, including:

• Modular ECLS Components: Development of cardiac, respiratory, and renal support modules to provide comprehensive care.
• Thrombo-resistant Circuits: Innovations aimed at reducing clot formation and improving patient safety.
• Wearable and Implantable Devices: Future directions in ECMO technology, including wearable and implantable devices to enhance mobility and quality of life.

Training and Team Collaboration

The importance of specialized training and interdisciplinary collaboration in ECMO management is emphasized. The session advocates for blended programs that involve perfusionists, nurses, and respiratory therapists working together to ensure optimal patient care.

Conclusion

The session concludes with a reflection on the future of pediatric ECMO, emphasizing the ongoing need for research, development, and training to improve outcomes and expand the use of this life-saving technology.