Extracorporeal Membrane Oxygenation - Complications

Complications

A common consequence in ECMO-treated adults is neurological injury, which may include subarachnoid hemorrhage, ischemic watershed infarctions, hypoxic-ischemic encephalopathy, unexplained coma, and brain death. Fatal sepsis may occur when the large catheters inserted in the neck provide fertile field for infection. Additional risks include bleeding. In adults, ECMO survival rates are around 60%. ECMO has yet to have proven survival benefit in adults with acute respiratory distress syndrome (ARDS). In VA ECMO, patients whose cardiac function does not recover sufficiently to be weaned from ECMO may be bridged to a ventricular assist device (VAD) or transplant.

In infants aged less than 34 weeks of gestation several physiologic systems are not well-developed, especially the cerebral vasculature and germinal matrix, resulting in high sensitivity to slight changes in pH, PaO₂, and intracranial pressure. Preterm infants are at unacceptably high risk for intraventricular hemorrhage (IVH) if administered ECMO at a gestational age less than 32 weeks. Also later, given the risk of IVH, it has become standard practice to ultrasound the brain prior to administering ECMO.