Abstract
Extracorporeal membrane oxygenation (ECMO) is a rescue treatment for newborns with severe respiratory insufficiency. In veno-arterial ECMO, venous blood is drained from the right atrium, oxygenated in an artificial lung and reinfused in the aorta. For vascular access the right internal jugular vein and right common carotid artery are ligated permanently. This invasive treatment may have major complications. In this thesis we described the results of ECMO treatment in the University Medical Center Nijmegen of 186 newborns over a period of 12.5 years. Survival varied between 65% and 95%, depending on the diagnosis. Major causes of death were respiratory insufficiency and intracranial haemorrhage. In this thesis we studied lung vascular morphology in newborns with pulmonary hypertension treated with ECMO and demonstrated a decrease in the abnormal morphometry that exists in the small pulmonary blood vessels.Furthermore, we studied the effects of ECMO on the brain. We demonstrated that intermittent opening of the so-called bridge, a safety connection in the ECMO circuit, has important negative effects on the cerebral oxygenation and circulation. This can be prevented with adaptation of this bridge. We also demonstrated that a patent ductus arteriosus with left to right shunt can diminish cerebral oxygenation and perfusion and should therefore be identified early. Others suggested that ECMO causes cerebral lesions predominantly in the right cerebral hemisphere, related to ligation of the right common carotid artery. We demonstrated that the initiation of ECMO has effects on the cerebral oxygenation and circulation, but that these effects were equal for both cerebral hemispheres. In veno-venous ECMO, drainage and reinfusion of blood take place both in the right atrium and ligation of the right common carotid artery is not necessary. To optimize the use of veno-venous ECMO it is important to be informed about recirculation. We developed a bedside method to quantify the amount of recirculation during veno-venous ECMO.
