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ECMO > ECMO and the Neonate > Flashcards

ECMO and the Neonate Flashcards

1
Q

Most common neonatal pulmonary disorders

A 
Meconium Aspiration Syndrome
Congenital Diaphragmatic Hernia
Hyaline Membrane Disease
Sepsis
Pulmonary Hyptertenion (PPHN) (may be primary or secondary)
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2
Q

MAS

A

Meconium aspiration syndrome

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3
Q

Which neonatal pulmonary disorders have a >90% survival rate?

A 
Meconium Aspiration
Primary Pulmonary Hypertension
Respiratory Distress Syndrome
Pneumonia
Massive Air Leak
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4
Q

Which neonatal pulmonary disorders have a 60% survival rate?

A

Congenital Diaphragmatic Hernia

Sepsis

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5
Q

Physiological Factors

A

Surfactant
Lung development
Fetal shunts

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6
Q

What does surfactant do/

A

Keeps alveoli open

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7
Q

What secretes surfactant?

A

Via type II alveolar cells

Phospholipid based

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8
Q

What are some fetal shunts

A

PFO
PDA
Ductus venosis

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9
Q

Meconium Aspiration syndrome (MAS)

A

the passage of meconium before birth secondary to hypoxia or stress

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10
Q

Meconium is in ____% of all deliveries.

A

10

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11
Q

What does MAS lead to?

A

PPHN

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12
Q

MAS: ECMO Notes

A

Straight forward cases
Do very well
VV if not severe cardiac suppression (VV conversion to VA)
Short duration

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13
Q

What is the most challenging pulmonary disorder to manage?

A

Congenital Diaphragmatic Hernia (CDH)

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14
Q

CDH

A 
malformation of diaphragm
herniation of abdominal contents into thoracic cavity
stomach, intestines, spleen and liver
L>R
presents as SEVERE Respiratory distress
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15
Q

CDH Treatment

A 
Resuscitation
Gastric decompression
Head up
ECMO
Surgical intervention on/off ECMO
may turn heparin off
B/U Circuit ready
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16
Q

CDH: ECMO Notes

A

UGLY cases
some times there is not enough lung to support life
a synthetic diaphragm does not assist ventilation as a phsyiological one

Be prepared to be on ECMO–>doing surgery –> NO heparin–> giving Amicar –> giving platelets –> waiting to clot

17
Q

HMD

A

Hyaline Membrane Disease

18
Q

Hyaline Membrane Disease

A 
characterized by lack of surfactant 
(atelectasis)
Turned off via hypoxia/acidosis
Decreased Qp = hypoxia nad hypercapnia
-anaerobic glycolysis --> lactate
19
Q

HMD Predisposition

A 
Premature kids
Asphyxia / hypoxia
Acidosis (can be severe)
Hypotension
diabetes
Male > female
20
Q

HMD Treatment

A 
Surfactant
PEEP
IMG
HFOV
ECMO (VV)
21
Q

HMD Effects

A

Thick alveolar walls (tough gas exchange)
Atelectasis
Necrosis

22
Q

HMD: ECMO Notes

A

Expect VV

Short pump run

23
Q

Pulmonary Hypertension Causes (PPHN)

A 
Hypoxia 
stress acidosis
hypotension
vasospasm
PA constriction
24
Q

PPHN Characteristics

A

Elevated PVR
Low Qp/Qs
R–> L shunts (PDA/PFO cyanotic)
preductal/post ductal gases differ

25
Q

High PVR=

A

more desaturated aortic blood

26
Q

PPHN Tx

A 
Prevent hypoxia
iNO
Maintain Qs and pressure
HFOV
ECMO (VV or VA)
27
Q

PPHN: ECMO Notes

A

Good success rate
treat the cause
get rid of the symptomology
very broad causal range of phsyiology

28
Q

Sepsis in the Neonate: Early Onset

A

Infection via the mother

  • Group B streptococcus infection during pregnancy
  • preterm delivery
  • water breaking (rupture of membranes) that lasts longer than 24 hours before birth
  • infection of hte placenta tissues and amniotic fluid (chorioamnionitis)
29
Q

Sepsis in the Neonate: Late Onset

A 
Infection druing/after delivery
-coagulase-negative staphylococcus
E coli
klebsiella
pseudomonas
enterbacter
candida
GBS 
Serratia
30
Q

Sepsis: Pediatric Septic Shock

A

Hypothermia or hyperthermia
Altered mental status
peripheral vasodilation (warm shock)
Cool extremities (cold shock)

31
Q

Why choose VA ECMO over VV ECMO in sepsis?

A

provides cardiac and respiratory support
decreases right ventricular preload
no risk of recirculation
better oxygen delivery

32
Q

Why NOT chose VA ECMO?

A 
increases left ventricular afterload
lowers pulse pressure
coronary oxygenation by LV blood
"Cardiac Stun"
decreased cerebral autoregulation
33
Q

Why choose VV ECMO?

A 
avoids major arterial cannulation
provides direct pulmonary oxygenation
improves coronary oxygneation
limits neurological complications
maintains pusality/CO
vasopressors not contraindication
34
Q

Why NOT choose VV ECMO?

A

may have inadequate oxygen delivery
dose not provide direct cardiac suppo
increased incidence of recirculation

35
Q

Conclusions

A

VV ECMO may be preferred with sepsis
decresaed mortality versus VA ECMO
most pronounced in neonatal period

ECMO (7 decks)

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