While extracorporeal membrane oxygenation (ECMO) can be used to manage neonates with cardiac or respiratory failure, it should only be used in carefully selected patients. It should not be used in the presence of one or more contraindications.
Contraindications to ECMO in Neonates
Rationale
body weight < 2 kilograms
small blood vessels make cannulation difficult and requires tubing with high resistance due to narrow gauge
gestational age < 34 weeks
prematurity associated with multiple under-developed organ systems
intraventricular hemorrhage (IVH) Grade > 1
risk of IVH increased with ECMO; grading discussed in 17.06.02
irreversible injury to brain, heart, liver and/or kidney
respiratory failure not reversible in 10-14 days
mechanical ventilation for > 7-10 days
overwhelming sepsis
severe coagulopathy
parental refusal
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