What are the possible medical complications of pediatric ECMO?

Updated: Dec 21, 2017
  • Author: Edwin Rodriguez-Cruz, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Answer

Neurologic complications include seizures. Intracranial bleeds and infarction may be due to ligation of the carotid artery and internal jugular vein, systemic heparinization, thrombocytopenia, coagulopathies, or systolic hypertension.

Hemorrhagic complications include hemorrhages and a decreased platelet count. Hemolysis and consumption coagulopathy may occur. Hemorrhage at the surgical site, at the cannula site, or into the site of a previous invasive procedure is a frequent complication because of systemic heparinization. Intrathoracic, abdominal, or retroperitoneal hemorrhage may also occur. Decreases in the platelet count occur because of decreased production, increased consumption, sequestration, or dilution.

Cardiac complications include myocardial stun, which is defined as a decrease in the left ventricular shortening fraction by more than 25% with initiation of ECMO that returns to normal after 48 hours of ECMO. In addition, hypertension is a dangerous complication because of the risk of hemorrhage and stroke. Arrhythmia may occur as a result of hypoxia and electrolyte imbalance. Symptomatic patent ductus arteriosus may occur, as well as pericardial tamponade may occur.

Pneumothorax is a potential pulmonary complication, along with pulmonary hemorrhage.

Oliguria is a commonly observed renal complication during the early part of ECMO; acute tubular necrosis is observed in some patients and may require hemofiltration and dialysis.

A study by Zwiers et al indicated that neonates who suffer acute kidney injury in association with ECMO are at increased risk for developing chronic kidney disease (CKD) and/or hypertension. In the study, 169 patients who had undergone neonatal ECMO were followed up for a median of 8.2 years. The investigators found at least one sign of CKD and/or hypertension in 54 (32%) of the participants, with a history of acute kidney injury being the only associated factor. The investigators also found, however, that most of the values related to chronic kidney disease (with regard to estimated glomerular filtration rate and urinary protein-to-creatinine ratio) were only marginally abnormal. [18]

GI tract complications include hemorrhage, which may occur as a result of stress, ischemia, or bleeding tendencies. Direct hyperbilirubinemia and biliary calculi may occur secondary to prolonged fasting and total parenteral nutrition (TPN), hemolysis, and diuretics.

Complications may also result from infection and sepsis, because the ECMO circuit represents a large intravascular foreign body, and frequent manipulation increases the risk of sepsis.

Metabolic complications include the following:

ECMO may alter serum concentration of drugs due to increased volume of distribution. Caution is warranted when narrow therapeutic drugs are administered, and dose alterations may be necessary. [19]


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