1.4 ECMO management
The standard circuit includes a centrifugal pump and HI-LITE 800LT hollow-fiber membrane oxygenator. The practice was to start with flow of 130-180 mL/kg/min with the average arterial blood pressure at 40-60 mmHg and the ventilator was adjusted to rest settings. If neonates experienced severe renal impairment, continuous renal replacement therapy (CRRT) was started immediately.
The standard anticoagulation is unfractionated heparin, ranging 5-40 units/ kg/min was administered to keep activated clotting time level at 160-200 seconds and activated partial thromboplastin time between 50 and 70 seconds. The blood components were transfused if hematocrit < 35%, platelet (PLT) count < 50×109/L, and fibrinogen < 1.5 g/L.
With the improvement of the clinical condition, if the neonate’s hemodynamic status was stable at 50 mL/kg/min pump flow, decannulation was anticipated.