EXTRACORPOREAL MEMBRANE OXYGENATION

ECMO is not performed at St. Paul Children's Hospital. Patients are transferred either to Minneapolis Children's or the University of Minnesota. The attending Neonatologist would determine where the patient is to be transferred.

ECMO Criteria:

• Oxygenation Index >30. OI = (Mean Airway Pressure x FiO2)/ PaO2

• Note: RA = 21, 100% = 100
• on 3 arterial blood gases at least 30 minutes apart

• AaDO2 > 600 for 8 hours Note: AaDO2 = (760–46) – PaO2 – PaCO2)
• Acute deterioration with PaO2 <35mmHg
• Shock and acidosis with pH <7.25
• Predicted mortality of at least 80%

Exclusion Criteria:

• Intracranial hemorrhage greater than Grade I
• Lethal chromosomal anomaly
• Major cardiac lesion
• <34 weeks gestational age
• <2000gms
• Coagulopathy that is ongoing/uncorrectable
• Mechanical ventilation for > 14 days
• Severe neurologic insult or asphyxia

Patients who could potentially qualify for ECMO should have a cardiac Echo and cranial ultrasound performed in a timely manner so that, should they meet ECMO criteria, these results are known. Blood gases, ventilator settings, and FiO2 should be followed closely so it is known when the critical OI or AaDO2 values are met.

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