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Cardiac performance in ECMO candidates: echocardiographic predictors for ECMO
J P Kinsella1, D C McCurnin, R H Clark
1Department of Pediatrics, Wilford Hall, USAF Medical Center, San Antonio, TX.
Journal of Pediatric Surgery
|January 11, 1992
Summary
Echocardiography can predict extracorporeal membrane oxygenation (ECMO) need in neonates with respiratory failure. Impaired cardiac function, indicated by lower flow velocities and acceleration, predicts ECMO requirement, aiding treatment decisions.
Area of Science:
- Neonatal Cardiology
- Pediatric Critical Care Medicine
- Echocardiography
Background:
- Severe respiratory failure in neonates often necessitates advanced support like extracorporeal membrane oxygenation (ECMO).
- Assessing cardiac function is crucial for managing these critically ill infants.
Purpose of the Study:
- To evaluate the role of echocardiographic parameters in predicting the need for ECMO in neonates with severe respiratory failure.
- To identify specific echocardiographic indices that differentiate neonates requiring ECMO from those who recover with conventional treatment.
Main Methods:
- Echocardiographic examinations were performed on 21 neonates with severe respiratory failure.
- Patients were treated with high-frequency oscillatory ventilation (HFOV), with ECMO as rescue therapy.
- Cardiac function indices including peak flow velocities, acceleration, and fractional shortening were analyzed.
Main Results:
- Nine patients required ECMO (Group 1), while 12 recovered without (Group 2).
- Group 1 showed significantly lower pulmonary and aortic peak flow velocities, lower pulmonary acceleration, and reduced shortening fraction compared to Group 2.
- Specific thresholds (pulmonary velocity < 0.70 m/s, pulmonary acceleration < 14 m/s²) predicted ECMO need with high accuracy.
Conclusions:
- Initial echocardiographic assessment reveals impaired cardiac performance in neonates who ultimately require ECMO.
- Echocardiography can be a valuable tool for predicting ECMO necessity and guiding timely transfer or treatment escalation.
- Cardiac dysfunction plays a significant role in determining ECMO candidacy for neonates with respiratory failure.