23-10-2024 | ECMO | Scientific Letter
Extracorporeal Membrane Oxygenation with Bi-Caval Dual-Lumen Catheter in a Neonate with Persistent Pulmonary Hypertension and Interventricular Septal Hypertrophy
Authors:
Sachin Dangi, Anup Thakur, Neelam Kler, Raja Joshi
Published in:
Indian Journal of Pediatrics
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Excerpt
To the Editor: A neonate was born via cesarian section at 36+2 wk gestation with a birth weight of 3.66 kg (98th percentile). She required intubation in delivery room due to persistent low oxygen saturation. APGAR score was 5 at 1 min and 7 at 5 min. Cord blood gas revealed pH 7.23, PCO2 41mmHg, PO2 29 mmHg, HCO3 17 mEq/L and lactate 3.1 mmol/L. She was supported on mechanical ventilation and surfactant was administered. Chest X-ray was normal. Echocardiography revealed features of pulmonary arterial hypertension and interventricular septal hypertrophy. Due to high ventilatory needs and oxygenation index (OI) of 21, she was supported on high-frequency ventilator and inhaled nitric oxide (iNO). At 5 HOL, she developed hypotension and low dose vasopressin was started. In view of partial response to iNO, IV Sildenafil was given. Pediatric extracorporeal membrane oxygenation (ECMO) team was activated. At 6 HOL, OI increased to 45 and a decision to proceed with ECMO was taken. Right internal jugular venous access was obtained via surgical cut-down. A 13Fr bi-caval dual-lumen catheter (Avalon; Maquet Cardiopulmonary, Rastatt, Germany) was placed under echocardiography guidance. Veno-venous (VV) ECMO was started at 8 HOL with a sweep rate of 500 ml/min, fractional sweep oxygen (FsO2) of 1 and pump speed of 2500 rpm to deliver ECMO flow of 500 ml/min. Gradually, patient’s oxygenation improved and finally on 6th day of life, successful decannulation was achieved. She was weaned to nasal ventilation on day 14 and discharged home on day 42 of life. …