Technique

Extracorporeal Life Support of Neonates with Congenital Cardiac Defects: Techniques Used During Cardiac Catheterization and Surgery

Departments of Cardiothoracic Surgery and Pediatric Cardiology, David M. Clark Cardiovascular Center, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas

^* Address correspondence to: Sherry C. Faulkner, CCP, Arkansas Children's Hospital, ECMO Unit, 800 Marshall Street, Little Rock, Arkansas 72202

Abstract

Neonatal patients with congenital cardiac defects require proper diagnosis often by cardiac catheterization before surgical repair. In our institution, patients whose echocardiograms reveal surgically correctable lesions, but who are severely decompensated, have been placed on Extracorporeal Life Support (ECLS) prior to catheterization or surgery. Subsequent management of ECLS and cardiopulmonary bypass (CPB) are dictated by the surgical procedure. Hypothermia can be utilized while on ECLS to facilitate low-flow CPB, or circulatory arrest. Total extracorporeal circulation may be performed with the ECLS circuit, or the patient may be transferred to a conventional CPB circuit during the procedure. If required, post surgical ECLS can be facilitated through prior cannulation. We have found pre-operative institution ofECLS, in the neonate with severe congenital cardiac defects, provides immediate control of hemodynamic and respiratory problems, lowers the risk of cardiac catheterization, and reduces the usage of blood products during surgery.