Hemodynamics guided care during extracorporeal membrane oxygenation (ECMO): a case report

Mohamed Al Kanjo; Regan E. Giesinger; Brady Thomas; Amy H. Stanford; Seth Jackson; Adrianne R. Bischoff; Patrick J. McNamara

doi:10.7363/130203

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Hemodynamics guided care during extracorporeal membrane oxygenation (ECMO): a case report

Journal article

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Hemodynamics guided care during extracorporeal membrane oxygenation (ECMO): a case report

Mohamed Al Kanjo, Regan E. Giesinger, Brady Thomas, Amy H. Stanford, Seth Jackson, Adrianne R. Bischoff and Patrick J. McNamara

Journal of pediatric and neonatal individualized medicine, Vol.13(2), e130203

08/01/2024

DOI: 10.7363/130203

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Abstract

Congenital diaphragmatic hernia (CDH) represents a population of high risk of major cardiopulmonary decompensation. Maintenance of patency of the patent ductus arteriosus (PDA), using intravenous prostaglandin, is a strategy used by some clinicians to decrease the risk of right ventricular dysfunction. A term infant with CDH presented with pulmonary hypertension unresponsive to aggressive hemodynamic support. Within 12 hours of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) initiation, circuit chugging occurred that was refractory to multiple volume boluses. Targeted neonatal echocardiography (TnECHO) revealed a high-volume left-to-right shunt across the PDA, resulting in decreased blood return to the right atrium. Interventions aimed at reducing the left-to-right PDA shunt led to the resolution of circuit chugging. This report highlights the unique challenge of VA-ECMO flow in the setting of a large PDA and the consequences of interventions, increasing PDA diameter or lowering pulmonary vascular resistance, on the magnitude of systemic-pulmonary shunting and systemic blood flow. TnECHO played a vital role in monitoring hemodynamics and guiding ECMO adjustments.

congenital diaphragmatic hernia (cdh)

extracorporeal membrane oxygenation (ecmo)

patent ductus arteriosus (pda)

targeted neonatal echocardiography (tnecho)

Details

Title: Subtitle: Hemodynamics guided care during extracorporeal membrane oxygenation (ECMO): a case report
Creators: Mohamed Al Kanjo - Division of Neonatology, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
Regan E. Giesinger - Division of Neonatology, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA
Brady Thomas - University of Iowa, Neonatology
Amy H. Stanford - University of Iowa, Stead Family Department of Pediatrics
Seth Jackson - Cardiovascular Services Program, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Adrianne R. Bischoff - University of Iowa
Patrick J. McNamara - University of Iowa
Resource Type: Journal article
Publication Details: Journal of pediatric and neonatal individualized medicine, Vol.13(2), e130203
DOI: 10.7363/130203
ISSN: 2281-0692
eISSN: 2281-0692
Publisher: Hygeia Press di Corridori Marinella; QUARTU SANT ELENA
Language: English
Date published: 08/01/2024
Academic Unit: Stead Family Department of Pediatrics; Neonatology; Internal Medicine
Record Identifier: 9984701558102771

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