At the end of January this year, “Little Hope” was discharged from the hospital with the joy of being reborn. On this day, the pediatric medical staff of the Third Hospital of Peking University were as happy as the family of “Little Hope”, because “Little Hope” was the first case of a newborn treated by extracorporeal membrane oxygenation (ECMO) implemented by the Pediatrics Joint Cardiac Surgery and other hospitals. . Recently, the Children’s Health Development Center of the hospital learned during follow-up that “Little Hope” has recovered well and has normal growth and development.
Recalling receiving help At the moment of the call, Zhu Weiwei, the attending pediatrician, was deeply impressed. On the other end of the phone, the 40-week term infant had severe postnatal asphyxia, meconium aspiration, persistent pulmonary hypertension, pulmonary hemorrhage, persistent respiratory failure and heart failure under the high-parameter respiratory support of tracheal intubation, and was in a very critical condition. Transshipment is urgently needed. Han Tongyan, Deputy Director of Pediatrics, and Wang Jing, Head Nurse, took the initiative to ask Ying to transport them together: “The child is too sick. Let’s go together and bring him back safely.”
At the same time, the ward began to make full preparations : Beds, ventilators, incubators, intubation, rescue medicines, ultrasound machines, the attending physician and chief physician of the ward were all present… About two hours later, the child was escorted by the transfer team into the neonatal intensive care unit of the Third Hospital of Peking University Room (NICU).
At that time, the patient was bruised and gray all over his body, his eyes were closed, the vital indicators on the monitor continued to alarm, and his condition was extremely critical. The NICU team immediately started the rescue process, but the child’s condition continued to deteriorate. The only thing that can create miracles is ECMO. However, neonatal ECMO is difficult, risky, and expensive to operate, and it has not been carried out in the pediatric department of the hospital before.
“No matter how difficult it is, we must save the child’s life.” Pediatric director Tong Xiaomei, deputy director Xing Yan, and cardiac surgery director Ling Yunpeng and other experts jointly consulted and decided to urgently start ECMO treatment.
The hospital’s medical department coordinated the ECMO treatment experts of many hospitals, and it took only two hours to set up the Pediatrics, Cardiac Surgery Department of the Third Hospital of Peking University, the Department of Intensive Medicine of Bayi Children’s Hospital, and the Department of Intensive Medicine of Anzhen Hospital. A neonatal ECMO treatment team composed of experts and an emergency preoperative interview were organized.
The father of the child said: “We believe in you! ECMO, we do it, we take all the risks.”
The ECMO technique is extremely difficult to operate, and it is applied to small-weight neonates On the body, it requires more precise operation, stricter monitoring, and requires the skilled cooperation of a professional team.
On the same day, the patient underwent ECMO under general anesthesia. During the operation, something unwilling to happen still occurred. The cardiopulmonary function of the child dropped sharply, and the heartbeat almost stopped. After many times of strong cardiopulmonary resuscitation by the NICU team, the heartbeat was finally restored. At this time, the ECMO team also cooperated tacitly, the catheter was successfully placed, the ECMO machine was successfully connected with the patient, and the diversion started. The skin color of the child gradually turned rosy, the hypoxia began to improve, and the blood gas analysis lactate gradually decreased. Looking at the green life indicator on the monitor, the medical team showed a rare smile on their faces.
However, various organ damage and postoperative complications follow one after another. After the operation, the NICU medical team experienced a sleepless 24 hours: due to postoperative coagulation disorders, oral bleeding continued, and the child experienced repeated hypotension and shock. “Doctor, the blood pressure has dropped, and the blood pressure has dropped again.” These are the words most often said by nurses in bed. After multiple transfusions of red blood cells, plasma, albumin, and hypertonic fluid replacement, the blood pressure finally stabilized. However, the child developed systemic edema, cerebral edema, pleural effusion, ascites, and decreased urine output. The ECMO team and The NICU team worked together to address various complications.
After 7 days of waiting day and night, “Little Hope” finally ushered in good news – the whole body edema has subsided, the lungs have been recruited, the pulmonary and cardiac functions have improved, and the lactic acid has returned to normal, meeting the conditions for weaning.
While everyone was still immersed in the joy of successful weaning, the condition of “Little Hope” deteriorated again, with hematuria, jaundice, progressive enlargement of liver and spleen, and edema… This is after ECMO weaning Complications: hemolysis and right heart failure. The NICU team took turns to stay by the child’s bedside and gradually resolve various complications after weaning and the primary lung disease.
During the recovery process of “Little Hope”, the nurse team took careful care and insisted on breastfeeding. The child gradually began to suck on his own, and the non-invasive respiratory support was slowly withdrawn. EEG and cranial MRI were used to evaluate the child. The nervous system functions normally. After staying with her mother for 3 days, “Little Hope” was successfully discharged from the hospital.
Text: Yang Dongping, special correspondent of Health News, correspondent Xu Xiao, Lu Danfang
Editor: Guan Zhongyao
Review: Xu Bingnan, Yan Yan