PEDIATRICS Vol. 106 No. 6 December 2000, pp. 1339-1343
Decreased Use of Neonatal Extracorporeal Membrane Oxygenation (ECMO): How New Treatment Modalities Have Affected ECMO Utilization
Received Oct 26 1999; accepted Mar 21 2000.
,
From the * Department of Pediatrics, Division of Neonatal
Medicine, Stanford University, Stanford, California; and Division of
Neonatology, San Diego Children's Hospital, San Diego, California.
Objective: Over the last decade, several new therapies, including high-frequency oscillatory ventilation (HFOV), exogenous surfactant therapy, and inhaled nitric oxide (iNO), have become available for the treatment of neonatal hypoxemic respiratory failure. The purpose of this retrospective study was to ascertain to what extent these modalities have impacted the use of neonatal extracorporeal membrane oxygenation (ECMO) at our institution.
Methods. Patients from 2 time periods were evaluated: May
1, 1993 to November 1, 1994 (group 1) and May 1, 1996 to November 1, 1997 (group 2). During the first time period (group 1), HFOV was not consistently used; beractant (Survanta) use for meconium
aspiration syndrome (MAS), persistent pulmonary hypertension of the
newborn (PPHN), and pneumonia was under investigation; and iNO was not yet available. During the second time period (group 2), HFOV and beractant treatment were considered to be standard therapies, and iNO
was available to patients with oxygenation index (OI) 
25 × 2 at
least 30 minutes apart, or on compassionate use basis. Patients were
included in the data collection if they met the following entry
criteria: 1) OI >15 × 1 within the first 72 hours of admission;
2) EGA 35 weeks; 3) diagnosis of MAS, PPHN or sepsis/pneumonia; 4)
<5 days of age on admission; and 5) no congenital heart disease, diaphragmatic hernia, or lethal congenital anomaly.
Results. Of the 49 patient in group 1, 21 (42.8%) required ECMO therapy. Of these ECMO patients, 14 (66.6%) had received diagnoses of MAS or PPHN. Only 3 of the patients that went on to ECMO received beractant before the initiation of bypass (14.3%). All ECMO patients in group 1 would have met criteria for iNO had it been available. Of all patients in group 1, 18 (36.7%) were treated with HFOV, and 13 (26.5%) received beractant. Of the 47 patients in group 2, only 13 (27.7%) required ECMO therapy (compared with group 1). Of these ECMO patients, only 5 (38.5%) had diagnoses of MAS or PPHN, with the majority of patients (61.5%) requiring ECMO for sepsis/pneumonia, with significant cardiovascular compromise. Only 5 of these ECMO patients, all outborn, did not receive iNO before cannulation because of the severity of their clinical status on admission. Of all patients in group 2, 41 (87.2%) were treated with HFOV (compared with group 1), 42 (89.3%) received beractant (compared with group 1), and 18 (44.7%) received iNO.
Conclusions. The results indicate that ECMO was used less frequently when HFOV, beractant and iNO was more commonly used. The differences in treatment modalities used and subsequent use of ECMO were statistically significant. We speculate that, in this patient population, the diagnostic composition of neonatal ECMO patients has changed over time. Key words: high-frequency oscillatory ventilation, exogenous surfactact therapy, inhaled nitric oxide, extracorporeal membrane oxygenation.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  A Karimova, K Brown, D Ridout, W Beierlein, J Cassidy, J Smith, H Pandya, R Firmin, M Liddell, C Davis, et al. Neonatal extracorporeal membrane oxygenation: practice patterns and predictors of outcome in the UK Arch. Dis. Child. Fetal Neonatal Ed., March 1, 2009; 94(2): F129 - F132. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. D. Pawlik, N. F. M. Porta, R. H. Steinhorn, E. Ogata, and R.-A. O. deRegnier Medical and Financial Impact of a Neonatal Extracorporeal Membrane Oxygenation Referral Center in the Nitric Oxide Era Pediatrics, January 1, 2009; 123(1): e17 - e24. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. A. Engle and and the Committee on Fetus and Newborn Surfactant-Replacement Therapy for Respiratory Distress in the Preterm and Term Neonate Pediatrics, February 1, 2008; 121(2): 419 - 432. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. S. Beardsmore, J. Westaway, H. Killer, R. K. Firmin, and H. Pandya How Does the Changing Profile of Infants Who Are Referred for Extracorporeal Membrane Oxygenation Affect Their Overall Respiratory Outcome? Pediatrics, October 1, 2007; 120(4): e762 - e768. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Walczak, D S. Lawson, D. Kaemmer, C. McRobb, P. McDermott, G. Smigla, I. Shearer, A. Lodge, and J. Jaggers Evaluation of a preprimed microporous hollow-fiber membrane for rapid response neonatal extracorporeal membrane oxygenation Perfusion, September 1, 2005; 20(5): 269 - 275. [Abstract] [PDF]
|
|
|
|
|
|
R. Hamutcu, T. A. Nield, M. Garg, T. G. Keens, and A. C.G. Platzker Long-Term Pulmonary Sequelae in Children Who Were Treated With Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure Pediatrics, November 1, 2004; 114(5): 1292 - 1296. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Lequier Extracorporeal Life Support in Pediatric and Neonatal Critical Care: A Review J Intensive Care Med, September 1, 2004; 19(5): 243 - 258. [Abstract] [PDF]
|
|
|
|
 |
|
 P. J. Wolfson The development and use of extracorporeal membrane oxygenation in neonates Ann. Thorac. Surg., December 1, 2003; 76(6): S2224 - 2229. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Carriedo and D. Deming Therapeutic Techniques: Neonatal ECMO NeoReviews, August 1, 2003; 4(8): e212 - 214. [Full Text] [PDF]
|
|
