33953 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age

Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO) / Extracorporeal Life Support (ECLS) Insertion of Peripheral Cannula(e), Open, Birth Through 5 Years of Age.

Summary

ECMO/ECLS is a life-support technique used for newborns and young children with severe heart or lung failure. The procedure involves inserting tubes (cannulae) into peripheral blood vessels to circulate and oxygenate blood outside the body, allowing the heart and lungs to rest and heal.

Purpose

ECMO/ECLS is used to treat severe cardiac or respiratory failure that is unresponsive to conventional treatments. The goal is to provide critical support while the underlying medical condition stabilizes and improves.

Indications

• Severe respiratory distress syndrome (RDS)
• Congenital diaphragmatic hernia
• Persistent pulmonary hypertension of the newborn (PPHN)
• Severe pneumonia or sepsis
• Heart failure or congenital heart defects
• Meconium aspiration syndrome

Preparation

• Patients may need to fast for several hours before the procedure.
• Pre-procedure imaging like an echocardiogram or chest X-ray may be required.
• Blood tests to evaluate clotting function and organ performance.

Procedure Description

1. The patient is transported to a specialized unit and sedated.
2. Sterilization of the insertion site (commonly the neck or groin) is performed.
3. An incision is made to access a suitable artery and vein.
4. Cannulae are inserted into the vessels and connected to the ECMO machine.
5. The machine circulates and oxygenates the blood externally.
6. Continuous monitoring for proper function and any complications.

Anesthesia: General anesthesia is used to ensure the patient remains unconscious and pain-free during the procedure.

Duration

The procedure typically takes 1-2 hours to complete.

Setting

The procedure is performed in a hospital, specifically in an intensive care unit (ICU) or a specialized ECMO center.

Personnel

• Pediatric or neonatal surgeon
• Critical care nurses
• Perfusionist (operates the ECMO equipment)
• Anesthesiologist
• Respiratory therapist

Risks and Complications

• Bleeding or clotting issues
• Infection at the cannula insertion site
• Mechanical failure of the ECMO machine
• Need for blood transfusions
• Stroke or other neurological impairment

Benefits

• Provides life-saving support for children with severe heart or lung conditions.
• Can reverse and stabilize life-threatening conditions.
• Allows time for other treatments to take effect and for the child's organs to recover.

Recovery

• Intensive monitoring in the ICU.
• Gradual weaning off ECMO as the child's condition stabilizes.
• Follow-up imaging and blood tests.
• Pain and sedation management.
• Physical therapy and rehabilitation might be necessary post-recovery.

Alternatives

• Mechanical ventilation
• Cardiac medications or interventions
• Other advanced life-support measures (less invasive, but potentially less effective depending on the severity of the condition)

Patient Experience

• The patient will be sedated and generally unaware during the procedure.
• Post-procedure, discomfort from incision sites and cannulae is managed with pain medications.
• Close monitoring for complications like infection or clotting issues.
• Gradual awakening and recovery in the ICU with supportive care.