A great number of infants who are treated for congenital diaphragmatic hernia will require ECMO (Extracorporeal Mebrane Oxygenation) in order to survive. ECMO is the last resort in many cases for not just CDH infants but also for other conditions.

Every parent who hears the staff state that their newborn requires this, our hearts jump out of our chests. We know how dire our child’s condition is at that time. Each and every hospital or medical center has their own criteria for ECMO and staffing. They also have their own standards for care while a child is on ECMO. Many are similar but they may deviate from one another slightly.

Venoarterial (VA) ECMO therapy is used when support for the heart and lungs is needed. A catheter is placed in a vein (veno) and an artery (arterial). VA bypass is normally used for infants with heart or blood pressure problems. A surgical procedure, often done at the bedside so as not to move a critically ill infant, is required for cannulation or the placement of catheters in vessels in the neck (an artery and vein). The unoxygenated blood is removed from the right atrium of the heart via the catheter placed in the right internal jugular vein that is threaded into the right atrium.

Venovenous (V-V) ECMO supports the lungs only. In the V-V ECMO procedure, the surgeon places a plastic tube into the jugular vein through a small incision in the neck. This is also a surgical procedure, often done at the bedside so as not to move a critically ill infant.

Oxygenated blood is returned to the baby via the catheter in the right common carotid artery threaded into the ascending aorta. The amount of time an infant can remain on ECMO varies depending on his/her condition and on the recovery of the heart and lung function. The age of the infant, the original illness, the amount of damage to the lungs prior to ECMO and any complications that may occur with ECMO will also determine the length of therapy. The maximum amount of time is approximately two weeks but there are cases which have been on ECMO longer. There are several complications associated with ECMO.

These include:

  1. Bleeding due to the heparinization of the blood in the ECMO circuit to prevent the blood from clotting,
  2. Infection because of the introduction of a foreign object (the catheters) into the body,
  3. Emboli can be air or tiny clots that move from the ECMO circuit into the infant’s bloodstream,
  4. Mechanical failure as a result of the circuit or any part of the equipment failing in its function. To provide ECMO specially trained staff is required. A physician who is familiar with ECMO and the infant’s care are required to be available 24 hours. An ECMO specialist trained in the equipment and the physiologic process to staff 24 hour care of the baby is also required.

Map of ECMO Centers all over the world:  https://www.elso.org/Registry/SupportDocuments/CenterIDList.aspx – We can not validate all of these and you may have to do your own research to validate that these hospitals do indeed have an ECMO Program.

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