Hemodynamics guided care during extracorporeal membrane oxygenation (ECMO): a case report
PDF

Keywords

congenital diaphragmatic hernia (CDH)
extracorporeal membrane oxygenation (ECMO)
patent ductus arteriosus (PDA)
targeted neonatal echocardiography (TnECHO)

How to Cite

Al Kanjo, M., Giesinger, R. E., Thomas, B., Stanford, A. H., Jackson, S., Bischoff, A. R., & McNamara, P. J. (2024). Hemodynamics guided care during extracorporeal membrane oxygenation (ECMO): a case report. Journal of Pediatric and Neonatal Individualized Medicine (JPNIM), 13(2), e130203. https://doi.org/10.7363/130203

Abstract

Congenital diaphragmatic hernia (CDH) represents a population of high risk of major cardiopulmonary decompensation. Maintenance of patency of the patent ductus arteriosus (PDA), using intravenous prostaglandin, is a strategy used by some clinicians to decrease the risk of right ventricular dysfunction. A term infant with CDH presented with pulmonary hypertension unresponsive to aggressive hemodynamic support. Within 12 hours of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) initiation, circuit chugging occurred that was refractory to multiple volume boluses. Targeted neonatal echocardiography (TnECHO) revealed a high-volume left-to-right shunt across the PDA, resulting in decreased blood return to the right atrium. Interventions aimed at reducing the left-to-right PDA shunt led to the resolution of circuit chugging. This report highlights the unique challenge of VA-ECMO flow in the setting of a large PDA and the consequences of interventions, increasing PDA diameter or lowering pulmonary vascular resistance, on the magnitude of systemic-pulmonary shunting and systemic blood flow. TnECHO played a vital role in monitoring hemodynamics and guiding ECMO adjustments.

https://doi.org/10.7363/130203
PDF