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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Extracorporeal membrane oxygenation (ECMO) is effective for newborns with pulmonary failure unresponsive to conventional therapy. However, ECMO for the older child and adult has been controversial and not widely utilized. Over 4 years, 24 patients (aged 4 months to 16 years; 11 boys, 13 girls) underwent venoarterial ECMO (duration, 7 to 19 days) for respiratory failure. The diagnoses were: viral pneumonia (7), hydrocarbon aspiration (6), sepsis with adult respiratory distress syndrome (ARDS) (2), bacterial pneumonitis (2), tracheal stenosis (1), bilateral pulmonary contusion (1), diaphragmatic hernia with ARDS (1), ketoacidosis with ARDS (1), pulmonary artery injection of hydrocarbon (1), drowning (1), and epiglottis with barotrauma (1). Pre-ECMO blood gas ranges (and means) were PO2 18 to 65 (46), and PCO2 47 to 112 (65). Nineteen patients received dopamine, dobutamine, or other inotrope for associated cardiac and/or renal failure. Cannulation for ECMO was through neck or groin vessels in 17, and sternotomy in 7. ECMO flow rates were 150 to 250 mL/kg/min, to maintain PO2 greater than 100 and PCO2 less than 40. Nine patients (41%) survived ECMO, with eight long-term survivors, (4 hydrocarbon aspiration or injection, 1 pulmonary contusion, 1 viral pneumonia, 1 ARDS, 1 barotrauma), three of whom have mild neurological deficit. All patients with sternotomy, and 8 of 15 with neck and/or groin cannulation, required 1 to 5 explorations for hemorrhage while on ECMO. All survivors had primarily pulmonary failure; patients with combinations of pulmonary, cardiac, and renal failure did not survive. ECMO can be life-saving in the child with isolated pulmonary failure, but its efficacy in patients with multiorgan failure is uncertain.
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PMID:Prolonged extracorporeal support for nonneonatal respiratory failure. 140 44

Conventional treatment of respiratory failure involves positive pressure ventilation with high concentrations of inspired oxygen. If adequate gas exchange still cannot be achieved extracorporeal membrane oxygenation (ECMO) may be an option. The general indication for ECMO for respiratory insufficiency is a reversible pulmonary disease, which cannot be managed by conventional means. ECMO is a modified heart-lung machine. Blood is withdrawn from a central vein in the patient and pumped through an artificial oxygenator back to the patient, either to a central artery (veno-arterial ECMO) or to a central vein (veno-venous ECMO). Total gas exchange can be achieved through the extracorporeal system, and the lungs do not have to be subjected to high-pressure ventilation. To date over 21,500 neonates have been treated with ECMO with an overall survival to hospital discharge of 76%. Meconium aspiration syndrome carries the highest survival (94%), whereas congenital diaphragmatic hernia on ECMO only has a survival of 52%. A total of 3500 pediatric patients (30 days to 18 years) have been treated with ECMO with a survival of 56%. Aspiration and viral pneumonia are the pediatric diagnoses with the highest survival rates. Randomized controlled studies have shown a significant advantage of ECMO with regard to survival in neonates. In the pediatric age group, nonrandomized studies have shown lower mortality in ECMO-treated patients.
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PMID:Respiratory failure and extracorporeal membrane oxygenation. 1815 40