THE USE OF A 2ND COURSE OF EXTRACORPOREAL MEMBRANE-OXYGENATION IN NEONATAL PATIENTS

Extracorporeal membrane oxygenation (ECMO) has been successful in resc uing near term or term infants in cardiorespiratory failure that resul ts from a reversible disease process. In most cases, only one course o f ECMO is needed to save these infants. However, a second course of EC MO may be beneficial in a select group of infants when recurrent persi stent pulmonary hypertension develops. Other than abstract form, this is the first report of the use of a second course of ECMO in the liter ature. The authors report on three infants, two with recurrent persist ent pulmonary hypertension secondary to congenital diaphragmatic herni a and one with necrotizing tracheobronchitis after Group B streptococc al sepsis who were treated at their institution with a second course o f ECMO. Technical considerations in using a second course of ECMO depe nd upon the initial vessel cannulation site, time elapsed between cann ulations, and the condition of the original artery and vein. By adopti ng a stenting procedure in those infants whose initial trial off was e quivocal, a second cannulation may be prevented in neonatal patients w ith recurrent persistent pulmonary hypertension.