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Extracorporeal membrane oxygenation (ECMO) for non-ECMO intensive care nurseries
E Thambapillai1, L W Doyle, L J Murton
1Division of Paediatrics, Royal Women's Hospital, Carlton, Victoria, Australia.
Journal of Paediatrics and Child Health
|October 1, 1990
Summary
This study found no clear predictors for 80% mortality in infants eligible for extracorporeal membrane oxygenation (ECMO) in non-ECMO centers. Transferring outborn infants directly to ECMO centers is recommended.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Cardiopulmonary Support
Background:
- A level 3 neonatal intensive care unit (NICU) in Melbourne established an extracorporeal membrane oxygenation (ECMO) center.
- Infants in non-ECMO centers may qualify for ECMO if predicted mortality exceeds 80% due to severe hypoxia.
- Transporting critically ill infants to an ECMO center poses additional risks.
Purpose of the Study:
- To identify predictors of at least 80% mortality in infants who might qualify for ECMO but were treated in a non-ECMO level 3 nursery.
- To inform transfer guidelines for critically ill neonates requiring advanced respiratory and circulatory support.
Main Methods:
- Retrospective analysis of infants treated in a non-ECMO level 3 nursery.
- Assessment of hypoxia severity and duration as potential mortality predictors.
- Comparison of outcomes for infants who met ECMO eligibility criteria.
Main Results:
- No specific group of infants with predicted mortality exceeding 80% was identified, irrespective of hypoxia severity or duration.
- Outborn infants were disproportionately represented among those potentially qualifying for ECMO.
- Mortality rates did not consistently reach the 80% threshold for ECMO consideration in this cohort.
Conclusions:
- Current criteria for ECMO referral may not accurately predict 80% mortality in non-ECMO settings.
- Preferential direct admission to the ECMO center for eligible outborn infants is advisable.
- Further research, potentially a randomized controlled trial, is needed to clarify the role of ECMO transfer for severely hypoxic infants in non-ECMO centers.