Pediatric Anaesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Eur J Pediatr. 2024 Apr;183(4):1509-1524. doi: 10.1007/s00431-023-05386-2. Epub 2024 Jan 18.
Extracorporeal membrane oxygenation (ECMO) is an invasive life support technique that requires a blood pump, an artificial membrane lung, and vascular cannulae to drain de-oxygenated blood, remove carbon dioxide, oxygenate, and return it to the patient. ECMO is generally used to provide advanced and prolonged cardiopulmonary support in patients with refractory acute cardiac and/or respiratory failure. After its first use in 1975 to manage a severe form of meconium aspiration syndrome with resultant pulmonary hypertension, the following years were dominated by the use of ECMO to manage neonatal respiratory failure and limited to a few centers across the world. In the 1990s, evidence for neonatal respiratory ECMO support increased; however, the number of cases began to decline with the use of newer pharmacologic therapies (e.g., inhaled nitric oxide, exogenous surfactant, and high-frequency oscillatory ventilation). On the contrary, pediatric ECMO sustained steady growth. Combined advances in ECMO technology and bedside medical management have improved general outcomes, although ECMO-related complications remain challenging. Point-of-care ultrasound (POCUS) is an essential tool to monitor all phases of neonatal and pediatric ECMO: evaluation of ECMO candidacy, ultrasound-guided ECMO cannulation, daily evaluation of heart and lung function and brain perfusion, detection and management of major complications, and weaning from ECMO support. Conclusion: Based on these considerations and on the lack of specific guidelines for the use of POCUS in the neonatal and pediatric ECMO setting, the aim of this paper is to provide a systematic overview for the application of POCUS during ECMO support in these populations. What is Known: • Extracorporeal membrane oxygenation (ECMO) provides advanced cardiopulmonary support for patients with refractory acute cardiac and/or respiratory failure and requires appropriate monitoring. • Point-of-care ultrasound (POCUS) is an accessible and adaptable tool to assess neonatal and pediatric cardiac and/or respiratory failure at bedside. What is New: • In this review, we discussed the use of POCUS to monitor and manage at bedside neonatal and pediatric patients supported with ECMO. • We explored the potential use of POCUS during all phases of ECMO support: pre-ECMO assessment, ECMO candidacy evaluation, daily evaluation of heart, lung and brain function, detection and troubleshooting of major complications, and weaning from ECMO support.
体外膜肺氧合（ECMO）是一种侵入性生命支持技术，需要血液泵、人工膜肺和血管插管，以排出缺氧的血液、去除二氧化碳、充氧并将其返回患者体内。ECMO 通常用于为难治性急性心功能和/或呼吸衰竭患者提供高级和长期心肺支持。1975 年首次用于治疗一种严重的胎粪吸入综合征，导致肺动脉高压后，接下来的几年，ECMO 主要用于管理新生儿呼吸衰竭，仅限于世界上少数几个中心。20 世纪 90 年代，新生儿呼吸 ECMO 支持的证据增加；然而，随着新型药物治疗（如吸入性一氧化氮、外源性表面活性剂和高频振荡通气）的应用，病例数量开始下降。相反，儿科 ECMO 持续稳定增长。ECMO 技术和床边医疗管理的综合进步改善了总体结果，尽管 ECMO 相关并发症仍然具有挑战性。即时超声心动图（POCUS）是监测新生儿和儿科 ECMO 所有阶段的重要工具：评估 ECMO 适应证、超声引导 ECMO 插管、每日评估心肺功能和脑灌注、检测和处理主要并发症，以及从 ECMO 支持中逐渐脱机。结论：基于这些考虑因素以及缺乏针对新生儿和儿科 ECMO 环境中 POCUS 使用的具体指南，本文旨在为这两种人群的 ECMO 支持期间 POCUS 的应用提供系统概述。已知内容：体外膜肺氧合（ECMO）为难治性急性心功能和/或呼吸衰竭患者提供高级心肺支持，需要进行适当的监测。即时超声心动图（POCUS）是一种可在床边评估新生儿和儿科心肺衰竭的便捷且可调整的工具。新内容：在本综述中，我们讨论了使用 POCUS 监测和管理接受 ECMO 支持的新生儿和儿科患者。我们探讨了在 ECMO 支持的所有阶段使用 POCUS 的潜在用途：ECMO 前评估、ECMO 适应证评估、心、肺和脑功能的每日评估、主要并发症的检测和故障排除，以及从 ECMO 支持中逐渐脱机。
