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Published on: October 24, 2018
Extracorporeal membrane oxygenation treatment. One-year outcomes for North Carolina infants
1University of North Carolina, Charlotte.
Insights
Extracorporeal membrane oxygenation (ECMO) shows promising survival rates for neonates with pulmonary failure, with developmental outcomes comparable to national data. Congenital diaphragmatic hernia is a key factor influencing poorer results.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Cardiopulmonary Support
Background:
- Extracorporeal membrane oxygenation (ECMO) is increasingly used for neonates with pulmonary failure.
- Initial survival rates in North Carolina's ECMO program exceeded national averages.
- Developmental outcomes at one year were comparable to existing literature.
Purpose of the Study:
- To evaluate the outcomes of neonatal ECMO treatment in North Carolina.
- To assess developmental functioning and family impact post-ECMO.
- To identify factors associated with treatment success or failure.
Main Methods:
- Retrospective analysis of the first 45 neonates treated with ECMO in North Carolina.
- Assessment of developmental functioning at one year of age.
- Evaluation of family functioning and perceived staff support.
Main Results:
- Survival rates were favorable compared to national benchmarks.
- Congenital diaphragmatic hernia was linked to significantly worse outcomes.
- Family functioning measures were similar to non-ECMO intensive care populations.
- ECMO staff support was highly rated by families.
Conclusions:
- ECMO has transitioned to an established treatment for neonatal pulmonary failure.
- Further research is needed on long-term effects and high-risk developmental follow-up.
- Refinement of ECMO techniques and patient selection criteria is ongoing.
Abstract:
Initial survival rates for the first 45 North Carolina ECMO neonates in the study group are somewhat better than national figures. Developmental functioning as assessed at one year of age is comparable to that reported in other studies. A congenital diaphragmatic hernia diagnosis was significantly related to poorer outcome. Measures of family functioning approximate those reported for families of non-ECMO neonates treated in intensive care. Support provided by ECMO staff was rated at a notably high level. With nearly three thousand survivors and multiple numbers of ECMO centers now operating in this country, ECMO has made the transition from an experimental treatment to an established procedure for treatment of neonates in pulmonary failure. A few beginning attempts to utilize ECMO with older patients are being made. Neonatologists are now directing efforts toward refining techniques and selection criteria. Further evaluation of longer-term effects of this type of treatment is essential. Effective protocols for follow-up care need to be designed, particularly for those at greatest risk for developmental disability.
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