ECMO-/ECLS

and allowing recirculation of extracorporeal blood flow through the bridge to
prevent thrombosis in the circuit. Although, it is often clear during the initial 15-
30 minutes whether ECLS may be discontinued, prolonged trials of up to 4 hours
may occasionally be required. During VV bypass, the gas phase of the
membrane lung may simply be capped indefinitely so that the patient remains on
extracorporeal support but without contribution of the artificial lung to gas
exchange. In patients with severe cardiac insufficiency, trials should be
performed with optimal pressor support, frequently accompanied by
echocardiographic evaluation to determine adjunct medications that may be
needed to wean off ECLS.[ 5 ]
For decannulation, the incision is opened and the right carotid artery
and/or internal jugular vein are ligated. Percutaneously placed cannulas may
simply be removed and prolonged pressure applied. The long term follow-up of
infants with right common carotid artery reconstruction demonstrated that nearly
two-thirds of the anastomoses were occluded or stenotic.[ 25 ]
Electroencephalography, neuroimaging, and neurodevelopmental follow up failed
to demonstrate any differences during the first year of life between those
newborns undergoing right common carotid artery reconstruction and historical
controls where the right common carotid artery was ligated. Another study
demonstrated that though the right internal carotid artery flow may be reduced
following ligation and ECLS in newborns, cerebral blood flow is normal in the
long term follow up.[ 5 ] Other theoretical risks of carotid artery reconstruction
include those of acute thromboembolism and atherosclerotic plaque formation