You are the physician on call for the extracorporeal membrane oxygenation (ECMO) service. There are 5 calls today, but only one machine and one technologist available. Which of the following patients is the most appropriate recipient of this service?
ECMO is a form of cardiopulmonary suppo that is useful in the setting of potentially reversible pulmonary or cardiac disease. Treatment of meconium aspiration syndrome, sepsis, pneumonia, and congenital diaphragmatic hernia (pre- or postoperatively) are thus appropriate uses. The technique is also applicable in some circumstances as a bridge to cardiac or lung transplantation since the outlook for survival is quite good if the child can be maintained in a good physiological state until donor organs are available. Hypoplastic lungs do not have enough surface area to perform adequate gas exchange and are unlikely to mature to a point where they can sustain life. Babies with hypoplastic lungs will be bypass-dependent for life and consequently are not candidates for institution of ECMO therapy.
A 1-day-old, full-term, anencephalic 4-kg boy suffering from meconium aspiration syndrome and hypoxia
A 75-year-old man with Alzheimer disease, severe pneumonia, and elevated pulmonary aerial pressure
A 5-year-old girl with rhabdomyosarcoma metastatic to the lungs
A 3-day-old boy preoperative for a congenital diaphragmatic hernia
Miscellaneous