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ECMO in premature infants. Review of factors associated with mortality
K C Bui1, P LaClair, J Vanderkerhove
1Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0331.
Insights
Extracorporeal membrane oxygenation (ECMO) survival for premature infants was low initially. Modern advancements suggest ECMO could achieve over 50% survival in high-risk neonates.
Area of Science:
- Neonatal Research
- Pediatric Critical Care
- Cardiopulmonary Support
Background:
- Early clinical research on neonatal extracorporeal membrane oxygenation (ECMO) in infants <35 weeks gestational age yielded low survival rates (25%).
- Intracranial hemorrhage was a significant complication, leading to initial recommendations against ECMO use in premature infants with respiratory failure.
Observation:
- A review of 16 historical ECMO cases revealed that 4 had contraindications and 5 experienced rare technical complications.
- Past anticoagulation and fluid management strategies differ significantly from current practices.
Findings:
- Improvements in diagnostic methods, indications, and extracorporeal support techniques are substantial.
- Current experience with near-term infants suggests improved outcomes are achievable.
Implications:
- It is reasonable to expect >50% survival for moribund premature infants with modern ECMO.
- New phase I trials with refined indications and technology are warranted to re-evaluate ECMO efficacy in this population.
Abstract:
During the first few years of clinical research on neonatal extracorporeal membrane oxygenation (ECMO), 16 premature infants of less than 35 weeks gestational age were treated by the authors (RHB), and only four (25%) survived. Intracranial hemorrhage was common, prompting the authors to recommend that ECMO not be used in premature infants with respiratory failure. Since diagnostic methods, indications, and techniques of extracorporeal support have improved considerably, the records of these previous cases were reviewed in detail to determine if there was reason to believe that results might be better in the modern era. Of the 16 patients, four had pre-ECMO conditions that would now be considered contraindications and five of the remaining patients had major technical complications that are now rare. Anticoagulation and fluid management of these patients also would be handled much differently. Based on this review and on current experience with extracorporeal support in near-term infants, it is reasonable to expect that survival of moribund premature infants might be 50% or greater with extracorporeal support. New phase I trials using improved indications and technology are suggested.