ABSTRACT
Extracorporeal membrane oxygenation (ECMO) has been used to describe a method of extracorporeal life support (ECLS) using extrathoracic cannulation for cardiopulmonary support. Vascular access for ECLS in the neonate is particularly challenging due to the small vessel size. The route of access depends on the method used. Venoarterial (VA) bypass is indicated if both cardiac and pulmonary support are required, and in neonates where access for venovenous (VV) support cannot be obtained. VV support is the method of choice for pulmonary failure and can adequately support most infants, including those with depressed cardiac function from high pressure ventilation used to manage their severe respiratory failure prior to ECMO. VA bypass requires arterial ligation to prevent distal embolization from flow past the cannula. Vascular cannulation and decannulation are performed in the neonatal intensive care unit under adequate sedation and neuromuscular blockade. The wound is irrigated with saline and hemostasis obtained.
