Extracorporeal membrane oxygenation 2001. The odyssey continues

Area of Science:

• Neonatal intensive care
• Pediatric critical care medicine
• Cardiopulmonary support

Background:

• Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for critically ill infants.
• Early studies focused on survival, lacking data on long-term neurodevelopmental outcomes and cost-effectiveness.
• Assessing the true impact of ECMO requires evaluating survivors' quality of life and healthcare economics.

Purpose of the Study:

• To evaluate the long-term neurodevelopmental outcomes of infants treated with ECMO.
• To analyze the cost-effectiveness of ECMO programs.
• To compare ECMO outcomes with alternative therapies.

Main Methods:

• Prospective cohort studies were utilized to track neurodevelopmental outcomes in post-ECMO survivors.
• Direct costs of ECMO programs were measured and compared to similar therapies.
• The impact of newer therapies like inhaled nitric oxide (iNO) on ECMO utilization and outcomes was assessed.

Main Results:

• ECMO increases the absolute number of children surviving severe respiratory failure, including those with disabilities.
• There is limited evidence that ECMO increases the relative percentage of handicapped children surviving.
• ECMO program costs are comparable to other advanced medical interventions when analyzed on a per-survivor basis.
• Newer therapies like iNO have not demonstrated cost-effectiveness or improved long-term outcomes compared to ECMO.

Conclusions:

• While ECMO effectively saves lives, it leads to an increased absolute number of survivors with disabilities.
• The relative risk of disability among survivors of severe respiratory failure is not significantly increased by ECMO.
• ECMO's cost is not an outlier when compared to other critical care therapies.
• Current alternative therapies have not proven to offer superior long-term outcomes or cost benefits over ECMO.