Successful gastrorrhaphy on ECMO

Charles G Howell, Robyn M Hatley, J. B. Davis, W. P. Kanto

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

From April 1985 to November 1987, over 100 infants were evaluated for extracorporeal membrane oxygenation (ECMO) in the treatment of respiratory failure. Of these infants, 40 underwent ECMO after failure of conventional treatment. Four developed gastroduodenal perforations. One developed a perforation prior to going on ECMO and died after several hours on ECMO, one developed a perforation while being treated conservatively for respiratory failure that never required ECMO, and two developed perforations requiring laparotomy while on ECMO. These two infants constitute the first report of successful gastrorrhaphy in infants while being supported by ECMO and anticoagulation with heparin. Particular measures helpful in the management of these infants included near-total cardiopulmonary bypass, reduction of the activated clotting time to 170 to 200, transverse abdominal incision for exposure, use of electrocautery, appropriate drainage of the operative site, insertion of a gastrostomy for gastric decompression and irrigation, rapid weaning from ECMO as soon as respiratory support could be provided by conventional methods, and the use of massive blood and platelet transfusions. In summary, 33 of 40 infants undergoing ECMO survived. Furthermore, two of the three infants with intestinal perforation who underwent ECMO have survived without significant short-term sequelae, and are 24 and 30 months of age, respectively. Therefore, we believe that despite severe respiratory failure requiring ECMO and anticoagulation with heparin, infants with intestinal perforation can be managed surgically with anticipated survival and good long-term prognosis.

Original languageEnglish (US)
Pages (from-to)1161-1162
Number of pages2
JournalJournal of Pediatric Surgery
Volume23
Issue number12
DOIs
StatePublished - Jan 1 1988

Fingerprint

Extracorporeal Membrane Oxygenation
Respiratory Insufficiency
Intestinal Perforation
Treatment Failure
Heparin
Gastric Lavage
Abdominal Muscles
Platelet Transfusion
Electrocoagulation
Gastrostomy
Decompression
Weaning
Cardiopulmonary Bypass
Laparotomy
Drainage

Keywords

  • Extracorporeal membrane oxygenation (ECMO)
  • gastroduodenal perforation, neonatal

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Successful gastrorrhaphy on ECMO. / Howell, Charles G; Hatley, Robyn M; Davis, J. B.; Kanto, W. P.

In: Journal of Pediatric Surgery, Vol. 23, No. 12, 01.01.1988, p. 1161-1162.

Research output: Contribution to journalArticle

Howell, Charles G ; Hatley, Robyn M ; Davis, J. B. ; Kanto, W. P. / Successful gastrorrhaphy on ECMO. In: Journal of Pediatric Surgery. 1988 ; Vol. 23, No. 12. pp. 1161-1162.
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