ECMO-/ECLS

discussion with attending SURGEON AND NEONATOLOGIST. The most experienced
person should intubate these babies since repeated intubations can damage either the
tracheal or esophageal repair.
When suctioning of salivary secretions is needed, the tip of the catheter should only
reach the posterior pharynx proximal to esophageal anastamosis (shallow suctioning).
Similarly, tracheal suctioning should not go beyond the end of the ETT.
The head of bed is at 45 degree angle to promote drainage of salivary secretions.
Some surgeons prefer the patient’s neck to be slightly flexed to decrease the tension on
the anastomosis. Other maneuvers to decrease the tension on the anastomosis include
mechanical ventilation for 3-5 days, with chin-to-chest position. Notably, there are no
data to support that these actually promote anastomotic healing.
A chest tube or chest drain is typically left during the procedure. There is usually no
injury to the lung and, therefore, no “air leak” is seen. The tip of the drain is placed
adjacent to the esophageal anastomosis. The drain is left in place until there is
fluoroscopic confirmation that the anastomosis is intact and there is no leak.
Prophylactic antibiotics (24 hrs) are given.
Parenteral nutrition is administered. Alternatively, a small orogastric feeding tube can
be passed at the time of the operation, and low volume feedings into the stomach. can
be initiated prior to the contrast esophagram
Contrast esophagram at 7-10d post-op to rule out leak. If no leak is seen, the baby is
started on oral feeding. The chest drain is removed. If a leak is seen, feeds are held
until another contrast esophagram documents an intact anastomosis (usually 7 days