ABSTRACT
This chapter discusses the selection criteria for extracorporeal membrane oxygenation (ECMO) in neonates and the management of these babies while on ECMO. It discusses ECMO for use in difficult clinical scenarios, such as congenital diaphragmatic hernia (CDH), and reviews outcome and follow-up of neonates treated with ECMO. ECMO support is best suited to infants with reversible or transient cardiorespiratory failure. Venoarterial (VA) ECMO involves drainage of venous blood from the infant and return of oxygenated blood into the aorta. This mode augments or replaces the function of both the heart and lungs. The tubing of the ECMO circuit is initially flushed with crystalloid and purged of all air bubbles. In the event of renal failure on ECMO, hemofiltration or hemodialysis can be added to the ECMO circuit for removal of excess fluid and electrolyte correction. During the course of ECMO, pulmonary toilet is essential to respiratory improvement and includes gentle chest percussion and postural drainage.
