Application of extracorporeal membrane oxygenation in newborns with refractory hypoxemia during medical evacuation

Extracorporeal membrane oxygenation is a modern therapeutic strategy aimed to stabilize vital function in a patient suffering from severe circulatory failure and refractory hypoxia.
Purpose. To describe two clinical cases of venoarterial extracorporeal membrane oxygenation in neonates with mеconium aspiration syndrome, complicated by persistent pulmonary hypertension and refractory hypoxia during medical evacuation.
Material and methods. The authors performed a comprehensive analysis of the condition specifics based on clinical and instrumental work up.
Results. We demonstrated that early application of venoarterial extracorporeal membrane oxygenation in neonates with meconium aspiration syndrome promotes the quickest possible stabilization and reverse of hypoxia and low cardiac output.
Conclusion. Venoarterial extracorporeal membrane oxygenation in neonates with meconium aspiration syndrome and refractory hypoxemia is a life-saving procedure, that can be applied during medical evacuation by qualified medical staff.

1. Extracorporal membrane oxygenation. Editor O.Je. Lucevich. SPb.: Jeksten medical, 2018; 72. (in Russ.)

2. Kornilov I.A. Extracorporeal life support in pediatric patients. Patologiya krovoobrashheniya i kardiokhirurgiya 2018; 22(4): 35–47. (in Russ.) DOI: 10.21688/1681-3472-2018-4-35-47

3. Khubulava G.G., Naumov A.B., Marchenko S.P., Suvorov V.V., Averkin I.I., Nevmerzhitskaya O.V. et al. Evaluating the effectiveness of resuscitation with extracorporeal membrane oxygenation in a model of acute hypoxic cardiac arrest in pigs (experimental study). Pediatr 2014; 4: 20–26. (in Russ.)

4. Maltseva O.S., Pshenisnov K.V., Shelukhin D.A. Naumov A.B., Marchenko S.P., Yakovlev A.V. et al. Extracorporal membrane oxygenation in pediatrics and the neonatology. Meditsina: teoriya i praktika 2018; 3(4): 108–114. (in Russ.)

5. Bokeriya L.A., Shatalov K.V., Lobacheva G.V., Har’kin A.V., Mahalin M.V., Brodskij A.G. et al. Method of extracorporeal membrane oxygenation in the treatment of heart failure in early age children in cardiac clinic. Detskiye bolezni serdtsa i sosudov 2012; 1: 19–25. (in Russ.)

6. Aleksandrovich Ju.S., Pshenisnov K.V. Respiratory support for critical conditions in pediatrics and neonatology. Moscow: GEOTAR-Media, 2020; 96. (in Russ.)

7. Shmakov A.N., Aleksandrovich Yu.S., Pshenisnov K.V., Zabolotskiy D.V., Razumov S.A. Intensive care of children who require interhospital transport (a clinical guideline draft). Al’manakh klinicheskoi meditsiny 2018; 46(2): 94–108. (in Russ.) DOI: 10.18786/2072-0505-2018-46-2-94-108

8. Shevchukova V. V. The organization of transportation of newborn children with different severity pathology. Pediatr 2011; 2(4): 96–98. (in Russ.)

9. Aleksandrovich Yu.S., Pshenisnov K.V., Andreyev V.V., Parshin Ye.V., Cherevatenko R.I., Nurmagambetova B.K. Outcomes for critical conditions in newborns depending on the time of interhospital transportation. Pediatr 2013; 3: 15–23. (in Russ.)

10. Aleksandrovich Yu.S., Pshenisnov K.V. Intensive therapy of neonate. St. Petersburg: N-L, 2013; 672. (in Russ.)

11. Gleason С., Juul S. Avery’s diseases of the newborn. Tenth edition. Philadelphia, PA: Elsevier, 2017; 1656.

12. Short B.L. Extracorporeal membrane oxygenation: use in meconium aspiration syndrome. J Perinatol 2008; 28(3): S79–83. DOI: 10.1038/jp.2008.152

13. Gehrmann L.P., Hafner J.W., Montgomery D.L., Buckley K.W., Fortuna R.S. Pediatric extracorporeal membrane oxygenation: an introduction for emergency medicine physicians. J Emerg Med 2015; 49(4): 552–660.

14. Amodeo I., Di Nardo M., Raffaeli G., Kamel S., Macchini F., Amodeo A. et al. Neonatal respiratory and cardiac ECMO in Europe. Eur J Pediatr 2021: 1–18. DOI: 10.1007/s00431-020-03898-9