Extracorporeal membrane oxygenation (ECMO) was firstly used in 1977 for the treatment of congenital diaphragmatic hernia (CDH) in a neonate. The first time ECMO was administered in our country to a child with CDH on the 10th of January, 2013, at the intensive care department of Municipal Pediatric Hospital No. 13 named after N.F. Filatov. However, the first patient with CDH who had received ECMO, had survived decannullation and had been discharged from the hospital arrived to this hospital only on the 12th of October, 2015. The aim of ECMO was to stabilize the child’s condition and to obtain an opportunity of surgical correction of the congenital malformation. Indications included increasing cardiopulmonary failure, hypoxemia (РаО 2 50, the alveolar-arterial oxygen gradient> 600 for 8 hours), combined acidosis, hypotension, suprasystemic pulmonary hypertension (main pulmonary artery pressure was higher than 100 mm Hg). There were no technical issues or complications during the procedure. Hemostatic therapy under the Activated Clotting Time (ACT) supervision, artificial lung ventilation (ALV), intravenous fluid and transfusion therapy were carried out. Cardiotonic therapy was canceled after the beginning of veno-arterial ECMO due to hemodynamic stabilization. Protective artificial ventilation was applied: VR-20; Pin-18mbar; PEEP-7mbar; FiO 2 -0,21. ACT was kept at 203 seconds in average at the average heparin infusion speed of 4 unit/kg/hour. Acidbase balance indicatiors: рН-7,38; РаО 2 -121,7 mm Hg, РаСО 2 -44,0 mm Hg, ВЕ-3,3, lactate 1,3. Average central venous pressure was 6,6 mm Hg., average invasive blood pressure - 51 mm Hg. After 72 hours of artificial circulatory support ECMO was canceled and surgical intervention was started after gas exchange and hemodynamic stabilization.

Лечение детей с врожденными стенозами трахеи по-прежнему является огромной проблемой как для хирурга, так и для анестезиолога-реаниматолога. Изначально операции проводились на фоне однолегочной искусственной вентиляции легких (ИВЛ) с использованием искусственного кровообращения, а в единичных случаях применяли экстракорпоральную мембранную оксигенацию (ЭКМО). С 2013 по 2014 г. в ДГКБ № 13 им. Н.Ф. Филатова впервые в Российской Федерации были проведены 5 операций у детей с пороком развития трахеи и бронхов с интраоперационным применением ЭКМО. Необходимость интраоперационного применения ЭКМО обусловлена несколькими причинами: во-первых, пациенты с врожденными стенозами трахеи очень часто болеют воспалительными заболеваниями легких и верхних дыхательных путей, что в свою очередь отражается в виде паренхиматозной недостаточности, во-вторых, при проведении у этих пациентов пробы с применением однолегочной ИВЛ получали заметное снижение оксигенации и напряжения кислорода в крови.

Coloesophagoplasty is indicated to children with oesophageal atresia and tracheoesophageal fistula or without it and with cicatrical or peptic oesophageal stenosis. Retrosternal coloesophagoplasty is performed in compliance with certain main principles, viz. isoperistaltic graft on the left colic artery, formation antireflux anastomosis with the stomach, graft length exactly matching the distance between anastomosis on the neck and the stomach. The severity of the postoperative period depends on the extent and the mode of surgical intervention, graft characteristics, oedema in the region of proximal anastomosis, unstable hemodynamics, intestinal paralysis, and infectious complications. In the postoperative period, artificial lung ventilation gradually gives way to spontaneous respiration, infusion therapy, parenteral nutrition, anesthesia according to a newly developed scheme and finally to enteral feeding. The study revealed peculiarities of preoperative and postoperative treatment in children undergoing coloesophagoplasty. It included comparative analysis of the number of patients, duration of artificial ventilation, and extubation time at the early and current stages of development of this surgical strategy.