Table of Contents

What is ECLS?

ECLS is a form of cardiopulmonary bypass that provides support for patients with reversible respiratory and/or cardiac failure. It is utilized in neonates and children who demonstrate at least an 80 percent predicted mortality secondary to inadequate oxygenation and ventilation despite maximal conventional management.

The following criteria for ECLS therapy are general guidelines. Patients who do not fulfill specific criteria are considered on an individual basis.

Neonatal ECLS Support

1. Minimum of 33 weeks of completed gestational age
2. Reversible pulmonary disease including:
   • meconium aspiration
   • idiopathic respiratory distress syndrome
   • sepsis with pneumonia
   • persistent pulmonary hypertension of the newborn
   • congenital diaphragmatic hernia
3. Predicted mortality of at least 80 percent

Pediatric Respiratory ECLS Support

Criteria defining mortality versus level of respiratory support are not currently available. Each potential ECLS pediatric respiratory failure patient will be considered on an individual basis.

Inclusion Criteria

1. Severe lung disease with high potential for mortality which has failed to respond to optimal conventional medical management
2. The disease process leading to respiratory failure has potential for reversibility and recovery

Exclusion Criteria

1. Provision of mechanical ventilatory support at levels such that significant (i.e. irreversible) lung injury is likely to have occurred (i.e. FiO2 >0.6 and/or PEEP >5 for more than 7 continuous days)
2. Acutely deteriorating neurologic injury
3. Immunodeficiency
   • - congenital/acquired associated with limited long-term survival
   • - deliberate pharmacologic (i.e. chemotherapy, transplantation)
4. Pre-existing severe chronic lung disease
5. Congenital anomalies and/or other medical conditions (i.e. irreversible organ failure) associated with limited long-term survival

Pediatric Cardiac ECLS Support

Criteria defining mortality risks are not currently available. Each potential ECLS pediatric cardiac failure patient will be considered on an individual basis.

Inclusion Criteria

1. Severe cardiovascular failure with high potential for mortality which has failed to respond to optimal conventional medical management
2. The disease process leading to cardiorespiratory failure has potential for reversibility and recovery

Exclusion Criteria

1. Acutely deteriorating neurologic injury (i.e. in neonates > grade I IVH)
2. Congenital anomalies and/or medical conditions (i.e. irreversible organ failure, congenital and/or acquired immunodeficiency) associated with limited long term survival.
.
3. Presence of a surgically correctable residual cardiac defect.

How do I predict Mortality?

Children's ECLS program uses the Oxygenation Index to predict mortality in neonates. In older children with respiratory failure, no standardized criteria exist which predict mortality. Therefore, pediatric patients beyond the neonatal period will be considered on an individual basis.

The Oxygenation Index is an artificial number calculated as follows:

 
Oxygenation Index =(mean airway pressure)(fraction of inspired oxygen)(100)
                    ------------------------------------------------------
                                        Postductal PaO2

An Oxygenation Index greater than or equal to 40 in neonates for a minimum of 2 to 4 hours identifies a mortality risk of at least 80 percent. When the predicted mortality is that elevated, the potential benefits of ECLS likely outweigh the recognized risks, and cannulation for ECLS is offered.

ECLS is not recommended when the child has:

• Major chromosomal anomalies incompatible with reasonable outcome
• Major cardiac or central nervous system malformations
• Intracranial hemorrhage greater than Grade I (subependymal)
• Ventilator support for greater than 10 days

Call the ECLS team before the Oxygenation Index criteria are met in order to help avoid the inherent risks of transporting a critically ill and possibly unstable patient. We suggest that you CONSULT THE ON-CALL ECLS PHYSICIAN WHEN THE OXYGENATION INDEX REACHES 20. A team member is available 24 hours a day to accept ECLS referrals and to answer questions.

The ECLS team can be reached through the Children's Hospital and Regional Medical Center paging operator at 206-987-2131. Please ask for the ECMO Physician on-call.

Specific questions and comments regarding ECLS therapy should be directed to Dr. McMullan at 206-987-2762.

Dr. McMullan can also be reached through the Hospital paging operator at any time, 206-987-2131.

Extracorporeal Life Support Organization

Extracorporeal Life Support Organization

Neonatal Respiratory Case Statistics - International Summary as of January, 2008

Extracorporeal Life Support Organization

Pediatric Respiratory Case Statistics - International Summary as of January, 2008

Extracorporeal Life Support Organization

Cardiac Case Statistics - International Summary as of January, 2008

ECLS-NET

Other ECLS Web Sites on the INTERNET