J Extra Corpor Technol
Volume 51, Number 2, June 2019
|Page(s)||88 - 93|
|Published online||15 June 2019|
Management Strategies during a VA ECMO Run in a Neonate with E. Coli Septic Shock Masquerading as Hypoxic Ischemic Encephalopathy
Address correspondence to: Vilmaris Quinones Cardona, MD, Division of Neonatology, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, 160 E Erie Avenue, Philadelphia, PA 19123. E-mail: email@example.com
Accepted: 3 April 2019
Advances in neonatal care for hypoxic respiratory failure, with high-frequency ventilation and inhaled nitric oxide, have led to a decreased need for extracorporeal membrane oxygenation (ECMO). However, neonates resistant to such therapies are more complex and at higher risk of mortality. One such population includes those with hypoxic ischemic encephalopathy (HIE) undergoing controlled hypothermia (CH). We present a challenging case of a full-term neonate with inotrope-resistant Escherichia coli septic shock, profound coagulopathy, hypoxic respiratory failure, and HIE requiring CH and venoarterial (VA) ECMO. We illustrate that family-centered decision-making, ECMO, primary team, and subspecialist support is critical to success. In addition, we share the strategic medical interventions concomitantly used with VA ECMO to aid in the survival of this high-risk infant such as continuous veno-venous hemofiltration with AN69 membrane for cytokine and fluid removal, prostaglandin use to relieve right ventricular strain in malignant pulmonary hypertension, and cautious use of bronchoscopy to assist in lung recruitment.
Key words: ECMO (extracorporeal membrane oxygenation) / neonate / hypoxia / hypothermia / shock
The senior author has stated that the authors have reported no material, financial, or other relationship with any healthcare-related business or other entity whose products or services are discussed in this paper.
Contributors’ Statement: Dr. Quinones Cardona obtained IRB approval, acquired and interpreted case report data, and drafted, reviewed, and revised the manuscript. Dr. Menkiti obtained IRB approval, interpreted case report data, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
© 2019 AMSECT
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