also not considered a contraindication but could be an indication for ECLS at
many centers.[ 21 ] Finally, as an ethical consideration, those patients with
profound neurologic impairment, multiple congenital anomalies, including severe
CDH or other conditions not compatible with meaningful life are excluded as
candidates for ECLS.
Additional relative exclusion criteria are the presence of irreversible
multiorgan system failure, major burns, severe immunodeficiency, chronic lung
disease, and the presence of an “incurable” disease process. It should be noted
that preoperative cardiac anomalies in newborns also represent a relative
contraindication to ECLS since they should be treated operatively, although they
may be supported with extracorporeal support until surgical intervention may be
accomplished.
B. Modes of ECLS
The basic configurations of ECLS are veno-arterial (VA) and veno-
venous (VV). Additional variations include single site double lumen VV
(DLVV) versus two sites. In the early experience, ECLS was almost
always performed using VA support since it offered the potential to replace
cardiac and lung function; however, significant disadvantages[ 5 ] include
- major artery must be cannulated and at least temporarily, sacrificed
- risk of dissemination of particulate or gaseous emboli into the systemic
circulation - pulmonary perfusion may be markedly reduced
- cardiac output may be compromised due to the presence of increased
ECLS circuit-induced afterload resistance - coronary arteries are predominantly perfused by relatively hypoxic left
ventricular blood