Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO) / Extracorporeal Life Support (ECLS) - Removal of Central Cannula(e) by Sternotomy or Thoracotomy, Birth through 5 Years of Age

Summary

In simple terms, this procedure involves removing tubes (cannulae) that were previously placed in the heart or major blood vessels of young children (birth to 5 years old) to provide life support. These tubes are removed through a surgical opening in the chest.

Purpose

ECMO/ECLS is used to support a child's heart and lungs when they are unable to function on their own. The goal of removing the cannulae is to fully wean the child off this external life support once their heart and lungs have recovered enough to function independently.

Indications

• Severe heart or lung failure where ECMO/ECLS was initiated as a life-saving measure.
• Improved patient condition indicating that the child no longer needs extracorporeal support.

Preparation

• Fasting may be required several hours before the procedure.
• Adjustments to medications may be necessary as per physician's instructions.
• Diagnostic tests, such as blood tests, chest X-rays, or echocardiograms, are performed to assess readiness for removal.

Procedure Description

1. Anesthesia: The child receives general anesthesia to ensure they are asleep and pain-free.
2. Surgical Access: A surgeon makes an incision in the chest (sternotomy or thoracotomy).
3. Cannula Removal: The cannulae are carefully removed from the heart or major blood vessels.
4. Closure: The incision is closed with sutures or staples.
5. Monitoring: The child's vital signs and heart/lung function are closely monitored throughout the procedure.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and the child's condition.

Setting

The procedure is performed in a hospital operating room, equipped for pediatric cardiac surgeries.

Personnel

• Pediatric cardiac surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (specialist who manages the ECMO machine)

Risks and Complications

• Bleeding
• Infection
• Blood clots
• Air embolism (air bubble entering the bloodstream)
• Adverse reactions to anesthesia
• Damage to surrounding tissues

Benefits

• Removal of dependency on ECMO/ECLS, allowing the child to breathe and have heart function independently.
• Reduced risk of complications associated with prolonged ECMO/ECLS use.

Recovery

• Post-operative care in an intensive care unit (ICU).
• Monitoring of heart and lung function, along with vital signs.
• Pain management with medications.
• Gradual increase in activity as the child recovers, usually within a few weeks.
• Follow-up appointments to monitor long-term recovery.

Alternatives

• Prolonged ECMO/ECLS support (though not preferable due to higher risk of complications).
• Other surgical or medical interventions as deemed necessary by the healthcare team.

Patient Experience

• During the procedure: The child will be under general anesthesia and will not feel any pain.
• After the procedure: The child may experience some discomfort or pain at the incision site, managed with pain medications.
• Emotional support and reassurance from healthcare providers and family members are crucial during recovery.