ECMO-/ECLS

related to clot formation within the circuit, overocclusion of the roller pump, or use
of a centrifugal pump. Hyperbilirubinemia is noted in 8% of patients and renal
insufficiency in 10%[ 4 ]. If the serum free hemoglobin is noted to be elevated, a
change in the circuit could be helpful to stifle this problem.
ICH can occur in about 13% of neonates, and at even higher rates in
premature infants due to the immature germinal matrix. To decrease the rate of
ICH, thrombocytopenia must be aggressively corrected, heparin infusion must be
carefully monitored, adequate oxygenation maintained while avoiding abrupt
changes to the pH and carbon dioxide levels. Management of ICH on ECLS
varies based on extent of bleeding from treatment with aminocaproic acid to
discontinuation of ECLS. Bleeding on ECLS can occur intracranial or at any other
site including at a surgical or procedure site, gastrointestinal, and pulmonary so
caution should be used with any procedure including IV placement, NG
placement or bronchoscopy. Disseminated intravascular coagulation (DIC) can
occur at any point during the course of an ECLS run and the most common
causes should be addressed promptly: gram-negative sepsis, acidosis, hypoxia
and hypotension. Finally, hypertension is seen most commonly with VA ECLS
and increases the likelihood of ICH; therefore, management with hydralazine,
nitroglycerin or captopril should be swiftly performed.[ 3 ]
In the early course of ECLS, myocardial depression can be common with
decreased left ventricular shortening fraction (LVSF) seen after initiation, and
improving slowly to normal after 48 hours. Impaired filling of the coronary arteries
and persistent subendocardial ischemia during early high-flow phases is thought