ECMO ECMO in Neonatal and Pediatric Populations 1 — Questions and Answers
Question 1: What is the minimum gestational age generally accepted as a criterion for neonatal ECMO candidacy?
- 30 weeks
- 32 weeks
- 34 weeks (Correct answer)
- 36 weeks
Correct answer: 34 weeks
Most centers require ≥34 weeks gestational age because premature neonates face prohibitively high rates of intracranial hemorrhage on ECMO anticoagulation.
Question 2: What is the most common indication for ECMO in neonates in the United States?
- Congenital diaphragmatic hernia (CDH)
- Meconium aspiration syndrome (MAS) (Correct answer)
- Group B Streptococcal sepsis
- Congenital heart disease
Correct answer: Meconium aspiration syndrome (MAS)
Meconium aspiration syndrome causing severe respiratory failure and pulmonary hypertension is the most frequent neonatal ECMO indication in the US.
Question 3: Which ECMO configuration is most commonly used in neonates requiring support?
- Veno-venous (VV) ECMO via double-lumen cannula
- Veno-arterial (VA) ECMO via neck vessels (Correct answer)
- Peripheral femoral VA-ECMO
- Central open-chest ECMO
Correct answer: Veno-arterial (VA) ECMO via neck vessels
Neonatal VA-ECMO via the right internal jugular vein and right common carotid artery provides both cardiac and respiratory support through accessible neck vessels.
Question 4: The oxygenation index (OI) threshold commonly used to consider ECMO in neonates is:
- >20
- >30
- >40 (Correct answer)
- >60
Correct answer: >40
An OI >40 (calculated as MAP × FiO2 × 100 / PaO2) on two or more blood gases indicates severe respiratory failure warranting ECMO consideration.
Question 5: What minimum body weight is typically required for neonatal ECMO candidacy at most US centers?
- 1.5 kg
- 2.0 kg (Correct answer)
- 2.5 kg
- 3.0 kg
Correct answer: 2.0 kg
A weight of at least 2.0 kg is the typical threshold because smaller neonates have vessels too small to cannulate safely without causing severe ischemia.
Question 6: Congenital diaphragmatic hernia (CDH) patients typically require longer ECMO runs than MAS patients because:
- CDH involves more severe cardiac malformations
- CDH lungs have structural hypoplasia that cannot reverse quickly (Correct answer)
- CDH patients are always premature
- CDH requires surgical repair before ECMO can be initiated
Correct answer: CDH lungs have structural hypoplasia that cannot reverse quickly
CDH causes pulmonary hypoplasia with reduced alveolar and vascular development, requiring prolonged support (often 2–3 weeks) for lung maturation.
ECMO ECMO in Neonatal and Pediatric Populations 1
What is the minimum gestational age generally accepted as a criterion for neonatal ECMO candidacy?