First experience of the usage of peripheral extracorporeal membrane oxygenation in a child with severe respiratory insufficiency

Abstract

Extracorporeal membrane oxygenation (ECMO) is a life-supporting technique in the treatment of severe cardiac and respiratory insufficiency. It is based on the prolonged extracorporeal blood circulation. Peripheral venoarterial ECMO involves withdrawing, gas exchange and returning blood through cannulas implanted in peripheral vessels. Objective. We are interested in analysing our experience of venoarterial membrane oxygenation with peripheral cannulation, which was used in a child aged eight months with severe respiratory insufficiency after the Ross-Konno operation. Materials and methods. The subject of this article is the patient’s case with severe respiratory insufficiency in the early post-operative period because of a bacterial infection. In spite of being transferred to the artificial lung ventilation, the child’s condition was worsening and the decision to use ECMO with peripheral cannulation was taken. In this particular case, there was cannulation of the right artery and right inner vein cava. Unfortunately, we had to discontinue ECMO because of a hematoma in the frontal lobe. Results and discussion. While maintaining ECMO, we managed to improve the patient’s condition and make it stable, evidenced by the laboratory and instrumental tests. This case is indicative of the possibility of using ECMO with peripheral cannulation in infants with severe respiratory insufficiency. Conclusions. ECMO is quite an effective method of treatment of severe respiratory insufficiency, which allows creating favourable conditions to overcome the infection and renew the pulmonary function. As compared with the central technique, the peripheral ECMO ensures sufficient gas-exchange even using cannulas of a smaller diameter. Peripheral cannulation is the efficacious way to avoid complications occurring during the central cannulation. The complications that occurred during venoatrial ECMO were reversible and not associated with cannulation.

Keywords

• extracorporeal membrane oxygenation
• peripheral cannulation
• severe respiratory insufficiency