Abstract
Extracorporeal Membrane Oxygenation (ECMO) provides critical support for patients with severe cardiac or respiratory failure, but device adaptation for small pediatric patients presents unique challenges. Yale New Haven Health system supports both a high-volume adult ECMO center and a low-volume pediatric ECMO center. After implementing the Medtronic VitalFlow ECMO System in our adult ECMO program, we expanded its use to support pediatric patients as small as 3 kg. Building on prior experience with the Maquet Cardiohelp device and a ¼-inch shunt pack, the transition to VitalFlow was seamless through the use of a modified circuit design, incorporating a bridge shunt, and enhanced monitoring systems.
This setup maintained institutional flow standards of 1000 mL/min while safely delivering lower patient flows. Supplemental monitoring—including flow and SvO2 measurements via a Spectrum Medical Viper Monitor and venous pressure assessment using a Medtronic DLP pressure box—ensured safe, accurate performance.
A representative 3.1 kg neonate with congenital diaphragmatic hernia (CDH) and coarctation of the aorta successfully underwent venoarterial (VA) ECMO and subsequent CDH surgical repair using this configuration. Four additional pediatric ECMO cases have since been supported, demonstrating reproducible safety and efficiency. This institutional experience supports the feasibility of using the Medtronic VitalFlow ECMO System in small pediatric patients, highlighting its adaptability, reliable performance, and potential to bridge the gap between adult and dedicated pediatric ECMO platforms.