The decannulation procedure is the same as for the

venous catheter, with the exception that an inspiratory

hold that is not required.

20. Give protamine (1 mg IV) after removal of both catheters.

Administration of protamine is not mandatory if

there is no significant bleeding.

21. Irrigate the wound with sterile saline and cauterize any

bleeding sites.

22. If desired, pack the wound with a thrombin-soaked

absorbable gelatin sponge and close the neck incision

using subcuticular horizontal sutures of 4-0 Vicryl.

23. Remove the sutures holding the cannula behind the

right ear.

24. Place povidone–iodine ointment over the incision and

cover with semipermeable transparent dressing.

F. Complications

1. Vessel laceration, which may require a sternotomy for

correction

2. Excessive blood loss

3. Venous air embolus

References

1. O’Rourke PP, Crone RK, Vacanti JP, et al. Extracorporeal membrane oxygenation and conventional medical therapy in neonates

with persistent pulmonary hypertension of the newborn: a prospective randomized study. Pediatrics. 1989;84:957.

2. UK Collaborative ECMO Trial Group. UK Collaborative

Randomised Trial of Neonatal Extracorporeal Membrane

Oxygenation. Lancet. 1996;348:75.

3. Elbourne D, Field D, Mugford M. Extracorporeal membrane

oxygenation for severe respiratory failure in newborn infants.

Cochrane Database Syst Rev. 2002:CD001340.

4. Kanto WP, Shapiro MB. The development of prolonged extracorporeal circulation. In: Zwischenberger JB, Steinhorn RH, Bartlet

RH, eds. Extracorporeal Cardiopulmonary Support in Critical

Care. 2nd ed. Ann Arbor, MI: Extracorporeal Life Support

Organization; 2000:27.

5. Rais-Bahrami K, Short BL. The current status of neonatal extracorporeal membrane oxygenation. Semin Perinatol. 2000;24:406.

6. Bartlett RH, Roloff DW, Custer JR, et al. Extracorporeal life support: the University of Michigan experience. JAMA. 2000;283:904.

7. Rais-Bahrami K, Van Meurs KP. ECMO for neonatal respiratory

failure. Semin Perinatol. 2005;29:15.

8. Sutton RG, Salatich A, Jegier B, et al. A 2007 survey of extracorporeal life support members: personnel and equipment. J Extra

Corpor Technol. 2009;41:172.

Fig. 33.10. Placement of Satinsky vessel clamp prior to removal

of ECMO catheter.