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Extracorporeal membrane oxygenation
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== Side effects and complications == ===Neurologic=== A common consequence in ECMO-treated adults is neurological injury, which may include intracerebral hemorrhage, [[subarachnoid hemorrhage]], ischemic infarctions in susceptible areas of the brain, hypoxic-ischemic encephalopathy, unexplained coma, and brain death.<ref name="pmid21825216"/> Bleeding occurs in 30 to 40% of those receiving ECMO and can be life-threatening. It is due to both the necessary continuous [[heparin]] infusion and [[platelet]] dysfunction. Meticulous surgical technique, maintaining platelet counts greater than 100,000/mm<sup>3</sup>, and maintaining the target [[activated clotting time]] reduce the likelihood of bleeding.{{citation needed|date=April 2015}} ===Blood=== [[Heparin-induced thrombocytopenia]] (HIT) is increasingly common among people receiving ECMO. When HIT is suspected, the heparin infusion is usually replaced by a non-heparin anticoagulant.<ref name="pmid17667231"/> There is retrograde blood flow in the descending aorta whenever the femoral artery and vein are used for VA (Veno-Arterial) ECMO. Stasis of the blood can occur if left ventricular output is not maintained, which may result in thrombosis.{{citation needed|date=April 2015}} ===Bridge-to-assist device=== In VA ECMO, those whose cardiac function does not recover sufficiently to be weaned from ECMO may be bridged to a ventricular assist device (VAD) or transplant. A variety of complications can occur during cannulation, including vessel perforation with bleeding, arterial dissection, distal ischemia, and incorrect location.{{citation needed|date=April 2015}} ===Children=== Preterm infants, having inefficiency of the heart and lungs, are at unacceptably high risk for [[intraventricular hemorrhage]] (IVH) if ECMO is performed at a gestational age less than 32 weeks.<ref name="RadiologySource"/> ===Infections=== The prevalence of hospital-acquired infections during ECMO is 10-12% (higher compared to other critically ill patients). [[Coagulase]]-negative staphylococci, ''Candida'' spp., ''Enterobacteriaceae'' and ''Pseudomonas aeruginosa'' are the most frequently involved pathogens. ECMO patients display a high incidence of ventilator-associated pneumonia (24.4 cases/1000 ECMO days), with a major role played by ''Enterobacteriaceae''. The infectious risk was shown to increase along the duration of the ECMO run, which is the most important risk factor for the development of infections. Other ECMO-specific factors predisposing to infections include the severity of illness in ECMO patients, the high risk of bacterial translocation from the gut and ECMO-related impairment of the immune system. Another important issue is the microbial colonisation of catheters, ECMO cannulae and the oxygenator.<ref>{{cite journal | vauthors = Biffi S, Di Bella S, Scaravilli V, Peri AM, Grasselli G, Alagna L, Pesenti A, Gori A | title = Infections during extracorporeal membrane oxygenation: epidemiology, risk factors, pathogenesis and prevention | journal = International Journal of Antimicrobial Agents | volume = 50 | issue = 1 | pages = 9β16 | date = July 2017 | pmid = 28528989 | doi = 10.1016/j.ijantimicag.2017.02.025 }}</ref>
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