2006 OPEN FORUM Abstracts
The Disposition of Neonatal Extracorporeal Membrane Oxygenation Referrals in a Children's Hospital
Lauren Perlman RRT-NPS, Peter Betit RRT-NPS, Anne Hansen MD, PhD.
Children's Hospital Boston and Harvard Medical School , Boston , MA
Introduction: Extracorporeal membrane oxygenation (ECMO) is used to support neonates with hypoxic respiratory failure (HRF) when advanced therapies such as high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (INO) are unsuccessful. Neonates from tertiary NICUs who are transported to our center for potential ECMO are prospectively tracked as part of a QI program. Patients with congenital diaphragmatic hernia and cardiac disease are not included.
Methods: We reviewed our database over a 5-year period. We evaluated ventilator mode; conventional mechanical ventilation (CMV) or HFOV, INO use, need for ECMO, and survival from 01/01 to 12/05.
Results: There were 101 patients referred to our center for possible ECMO; 2 CMV, 6 CMV+INO, 8 HFOV, and 85 HFOV+INO. Of the total referrals 20 (20%) required ECMO, all from the HFOV+INO subset. Overall 92 (91%) patients survived. The 9 (9%) deaths all occurred in the ECMO group; 3 multi-system organ failure,
3 intracranial hemorrhages, and 3 alveolar capillary dysplasia.
|Year||Pts.||CMV||CMV + INO||HFOV||HFOV + INO||ECMO||Survival|
Discussion: Advanced therapies such as HFOV and INO have reduced
the need for ECMO in neonates with HRF however it has not eliminated its use.
Our data suggests that the need for ECMO in neonates with HRF is 20%. The number
of ECMO referrals decreased over the 5-year period which may reflect an
increased availability and expertise with advanced therapies in non-ECMO
centers. We consider the need for ECMO to be low, and speculate that because of
the availability of ECMO, we were able to use higher HFOV mean airway pressures
than the referring centers, and that this strategy may have improved alveolar
recruitment and INO response. While most patients did not require ECMO, the
morbidity associated with strategies used to prevent ECMO is not known and
should be followed in the future. The high survival rate that we observed may
be attributed to the referring center's timely referral. Treatment failure
criteria, including the proximity to an ECMO center, should be established by
tertiary NICUs using advanced therapies.