Life-threatening intrathoracic complications during treatment with extracorporeal membrane oxygenation

Joseph B. Zwischenberger, Robert E. Cilley, Ronald B. Hirschl, Kurt F. Heiss, Vincent Conti, Robert H. Bartlett

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Extracorporeal membrane oxygenation (ECMO) has been successful (>80% survival) in 35 centers in >900 newborns with severe respiratory failure having an estimated mortality of >80% on conventional management. During the last 3 years we have treated 79 newborns with 74 survivors (94%). Their diagnoses included meconium aspiration, persistent fetal circulation, respiratory distress syndrome, congenital diaphragmatic hernia, and sepsis. Seven patients (9%) had life-threatening intrathoracic complications requiring emergent intervention while on ECMO: tension hemothorax (3), tension pneumothorax (2), and pericardial tamponade (2). Pericardial tamponade and tension hemothorax and pneumothorax show a similar pathophysiology of increasing intrapericardial pressure and decreasing venous return. Perfusion is initially maintained by the nonpulsatile flow of the ECMO circuit before further decrease in venous return results in decreasing ECMO flow and progressive hemodynamic deterioration. Each of the seven patients demonstrated a clinical triad that includes increasing PaO2 and decreasing peripheral perfusion (as evidenced by decreasing pulse pressure and decreasing SvO2) followed by decreasing ECMO flow with progressive deterioration. The diagnoses were confirmed by transillumination, chest x-ray, or cardiac echocardiogram. Initial emergent placement of a percutaneous drainage catheter was temporizing in all seven cases. However, four patients required emergent thoracotomy for definitive treatment while still on ECMO. All seven patients were weaned from ECMO and are short-term survivors (6 months to 3.5 years). As use of ECMO for newborn severe respiratory failure increases, responsible physicians must be familiar with life-threatening intrathoracic complications and appropriate treatment strategies.

Original languageEnglish (US)
Pages (from-to)599-604
Number of pages6
JournalJournal of Pediatric Surgery
Volume23
Issue number7
DOIs
StatePublished - 1988
Externally publishedYes

Fingerprint

Extracorporeal Membrane Oxygenation
Hemothorax
Cardiac Tamponade
Newborn Infant
Pneumothorax
Therapeutics
Respiratory Insufficiency
Survivors
Perfusion
Persistent Fetal Circulation Syndrome
Meconium Aspiration Syndrome
Transillumination
Venous Pressure
Thoracotomy
Drainage
Sepsis
Thorax
Catheters
Hemodynamics
X-Rays

Keywords

  • Extracorporeal membrane oxygenation (ECMO)
  • pericardial tamponade
  • tension hemothorax
  • tension pneumothorax

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Life-threatening intrathoracic complications during treatment with extracorporeal membrane oxygenation. / Zwischenberger, Joseph B.; Cilley, Robert E.; Hirschl, Ronald B.; Heiss, Kurt F.; Conti, Vincent; Bartlett, Robert H.

In: Journal of Pediatric Surgery, Vol. 23, No. 7, 1988, p. 599-604.

Research output: Contribution to journalArticle

Zwischenberger, Joseph B. ; Cilley, Robert E. ; Hirschl, Ronald B. ; Heiss, Kurt F. ; Conti, Vincent ; Bartlett, Robert H. / Life-threatening intrathoracic complications during treatment with extracorporeal membrane oxygenation. In: Journal of Pediatric Surgery. 1988 ; Vol. 23, No. 7. pp. 599-604.
@article{a89142e514bb4b32a3ffe84f6bd94e0a,
title = "Life-threatening intrathoracic complications during treatment with extracorporeal membrane oxygenation",
abstract = "Extracorporeal membrane oxygenation (ECMO) has been successful (>80{\%} survival) in 35 centers in >900 newborns with severe respiratory failure having an estimated mortality of >80{\%} on conventional management. During the last 3 years we have treated 79 newborns with 74 survivors (94{\%}). Their diagnoses included meconium aspiration, persistent fetal circulation, respiratory distress syndrome, congenital diaphragmatic hernia, and sepsis. Seven patients (9{\%}) had life-threatening intrathoracic complications requiring emergent intervention while on ECMO: tension hemothorax (3), tension pneumothorax (2), and pericardial tamponade (2). Pericardial tamponade and tension hemothorax and pneumothorax show a similar pathophysiology of increasing intrapericardial pressure and decreasing venous return. Perfusion is initially maintained by the nonpulsatile flow of the ECMO circuit before further decrease in venous return results in decreasing ECMO flow and progressive hemodynamic deterioration. Each of the seven patients demonstrated a clinical triad that includes increasing PaO2 and decreasing peripheral perfusion (as evidenced by decreasing pulse pressure and decreasing SvO2) followed by decreasing ECMO flow with progressive deterioration. The diagnoses were confirmed by transillumination, chest x-ray, or cardiac echocardiogram. Initial emergent placement of a percutaneous drainage catheter was temporizing in all seven cases. However, four patients required emergent thoracotomy for definitive treatment while still on ECMO. All seven patients were weaned from ECMO and are short-term survivors (6 months to 3.5 years). As use of ECMO for newborn severe respiratory failure increases, responsible physicians must be familiar with life-threatening intrathoracic complications and appropriate treatment strategies.",
keywords = "Extracorporeal membrane oxygenation (ECMO), pericardial tamponade, tension hemothorax, tension pneumothorax",
author = "Zwischenberger, {Joseph B.} and Cilley, {Robert E.} and Hirschl, {Ronald B.} and Heiss, {Kurt F.} and Vincent Conti and Bartlett, {Robert H.}",
year = "1988",
doi = "10.1016/S0022-3468(88)80626-2",
language = "English (US)",
volume = "23",
pages = "599--604",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - Life-threatening intrathoracic complications during treatment with extracorporeal membrane oxygenation

AU - Zwischenberger, Joseph B.

AU - Cilley, Robert E.

AU - Hirschl, Ronald B.

AU - Heiss, Kurt F.

AU - Conti, Vincent

AU - Bartlett, Robert H.

PY - 1988

Y1 - 1988

N2 - Extracorporeal membrane oxygenation (ECMO) has been successful (>80% survival) in 35 centers in >900 newborns with severe respiratory failure having an estimated mortality of >80% on conventional management. During the last 3 years we have treated 79 newborns with 74 survivors (94%). Their diagnoses included meconium aspiration, persistent fetal circulation, respiratory distress syndrome, congenital diaphragmatic hernia, and sepsis. Seven patients (9%) had life-threatening intrathoracic complications requiring emergent intervention while on ECMO: tension hemothorax (3), tension pneumothorax (2), and pericardial tamponade (2). Pericardial tamponade and tension hemothorax and pneumothorax show a similar pathophysiology of increasing intrapericardial pressure and decreasing venous return. Perfusion is initially maintained by the nonpulsatile flow of the ECMO circuit before further decrease in venous return results in decreasing ECMO flow and progressive hemodynamic deterioration. Each of the seven patients demonstrated a clinical triad that includes increasing PaO2 and decreasing peripheral perfusion (as evidenced by decreasing pulse pressure and decreasing SvO2) followed by decreasing ECMO flow with progressive deterioration. The diagnoses were confirmed by transillumination, chest x-ray, or cardiac echocardiogram. Initial emergent placement of a percutaneous drainage catheter was temporizing in all seven cases. However, four patients required emergent thoracotomy for definitive treatment while still on ECMO. All seven patients were weaned from ECMO and are short-term survivors (6 months to 3.5 years). As use of ECMO for newborn severe respiratory failure increases, responsible physicians must be familiar with life-threatening intrathoracic complications and appropriate treatment strategies.

AB - Extracorporeal membrane oxygenation (ECMO) has been successful (>80% survival) in 35 centers in >900 newborns with severe respiratory failure having an estimated mortality of >80% on conventional management. During the last 3 years we have treated 79 newborns with 74 survivors (94%). Their diagnoses included meconium aspiration, persistent fetal circulation, respiratory distress syndrome, congenital diaphragmatic hernia, and sepsis. Seven patients (9%) had life-threatening intrathoracic complications requiring emergent intervention while on ECMO: tension hemothorax (3), tension pneumothorax (2), and pericardial tamponade (2). Pericardial tamponade and tension hemothorax and pneumothorax show a similar pathophysiology of increasing intrapericardial pressure and decreasing venous return. Perfusion is initially maintained by the nonpulsatile flow of the ECMO circuit before further decrease in venous return results in decreasing ECMO flow and progressive hemodynamic deterioration. Each of the seven patients demonstrated a clinical triad that includes increasing PaO2 and decreasing peripheral perfusion (as evidenced by decreasing pulse pressure and decreasing SvO2) followed by decreasing ECMO flow with progressive deterioration. The diagnoses were confirmed by transillumination, chest x-ray, or cardiac echocardiogram. Initial emergent placement of a percutaneous drainage catheter was temporizing in all seven cases. However, four patients required emergent thoracotomy for definitive treatment while still on ECMO. All seven patients were weaned from ECMO and are short-term survivors (6 months to 3.5 years). As use of ECMO for newborn severe respiratory failure increases, responsible physicians must be familiar with life-threatening intrathoracic complications and appropriate treatment strategies.

KW - Extracorporeal membrane oxygenation (ECMO)

KW - pericardial tamponade

KW - tension hemothorax

KW - tension pneumothorax

UR - http://www.scopus.com/inward/record.url?scp=0023908750&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0023908750&partnerID=8YFLogxK

U2 - 10.1016/S0022-3468(88)80626-2

DO - 10.1016/S0022-3468(88)80626-2

M3 - Article

VL - 23

SP - 599

EP - 604

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 7

ER -