The document discusses patient selection and management for pediatric and adult extracorporeal membrane oxygenation (ECMO). ECMO is considered for acute, life-threatening respiratory or cardiac conditions that are potentially reversible and unresponsive to conventional therapies. Younger age, fewer days on ventilation pre-ECMO, and better oxygenation predict survival. Venovenous ECMO is preferred over venoarterial when possible. Management involves lung rest through ventilator optimization, maintenance of adequate oxygenation and circulation, and treatment of complications like bleeding and infection during the ECMO run. Weaning and decannulation criteria include clinical and radiographic improvement allowing reduction and then discontinuation of ECMO support.

1. Pediatric and Adult ECMO: Patient Selection and Management James D. Fortenberry, MD Clinical Director, Pediatric and Adult ECMO Children’s Healthcare of Atlanta at Egleston

3. Number of neonatal and pediatric ECLS treatments on an annual basis reported to ELSO registry

4. All who drink of this treatment recover within a short time, except in those who do not. Therefore, it fails only in incurable cases -Galen

7. -Green et al., CCM 1996 *

10. Vats et al. Crit Care Med 1998; 26:1587-1592 Cost/life-year-saved of pediatric extracorporeal life support (ECLS) with adult therapies

11. Pediatric ECMO - Children’s Healthcare of Atlanta

13. Adults are just Big Kids

15. Diagnoses for Pediatric ECLS From: Registry of the Extracorporeal Life Support Organization(ELSO, Ann Arbor, MI, USA).

18. Oxygenation Index OI= Mean airway pressure x F i O 2 x 100 PaO 2

28. “ The key to the success of ECMO may be the time of initiation” Plotkin et al., U of M, 1994

29. ECMO Initiation Surgical Team

30. VA ECMO VV vs. Selection of Technique

33. Use of VV and VV ECMO: Egleston Pediatric Experience

34. Equipment

37. Size of Circuit Components Based on Patient Weight 1 Two oxygenators necessary in parallel or in series 2 Minimal sizes of cannulas

49. Surgeons give fluid Intensivists give Lasix (or use CVVH)

58. Questions??