for Consideration of ECMO
|Approved by Clinical Guidelines Committee|
|Eligibility Criteria||Contraindications||Pre-ECMO Investigations|
|Optimal Pre-ECMO Tubes and Lines||Consideration of ECMO|
ECMO is proven treatment for life-threatening respiratory and/or cardiac failure in neonates. Overall survival rates are approximately 80% in infants with a predicted survival of 20%.
ANY of the following AND underlying disease process which is likely to be reversible
|1.||OI ≥30 - 60 for 0.5 - 6 hours||OI =
(MAP x FiO2 x 100) / PaO2 (mmHg) (click
here to open the OI calculator)
Standard criteria: OI ≥40 on conventional ventilation
OI ≥50-60 for HFOV
|2.||PaO2 <5.3kPa (40mmHg) for >2 hours or PaO2 <6.7-8.0kPa (50-60mmHg) for 2-12 hours||Despite maximal ventilatory support|
|3.||Acidosis and Shock||pH
<7.25 due to metabolic acidosis
|FBC and Differential||NICU|
|INR, APPT, Fibrinogen||NICU|
Urea and Creatinine
|Head Ultrasound Scan||NICU|
|Cardiac Echo||NICU but should have repeat study performed by Paediatric Cardiologist prior to cannulation|
|Crossmatch (2 adult units)||NICU|
|Peripheral arterial line||NICU||
|Double lumen umbilical venous catheter||NICU|
|Double lumen femoral venous catheter||PICU||May be inserted by PICU team if time before cannulation.|
With the advent of HFOV and nitric oxide, patients being referred for ECMO will generally be sicker than previously with little or no reserve. As a treatment with a proven survival benefit, ECMO should be considered for any neonate with severe cardio-respiratory failure and discussed early to facilitate timely transfers.
Discuss all infants who are potential ECMO candidates early with the PICU Consultant on call.
As many as possible of the pre-ECMO investigations, tubes and lines should be done prior to transfer to allow for rapid initiation of ECMO if it is required.
Consider and discuss ECMO in any near-term neonate with:
If a decision is made to transfer to PICU: