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Hidden mortality rate associated with extracorporeal membrane oxygenation
R F Boedy1, C G Howell, W P Kanto
1Section of Neonatology, Medical College of Georgia, Augusta 30912-3741.
Insights
Extracorporeal membrane oxygenation (ECMO) can save lives, but timely transport is crucial. Early transfer for infants with congenital diaphragmatic hernia or meconium aspiration syndrome may improve survival rates.
Area of Science:
- Pediatric Critical Care
- Neonatology
- Cardiopulmonary Support
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support technology for neonates with severe cardiorespiratory failure.
- Evaluating the outcomes and identifying factors influencing survival in neonatal ECMO programs is essential for optimizing patient care.
Purpose of the Study:
- To review the outcomes of infants referred to and treated with ECMO.
- To identify factors affecting survival, including transport-related mortality.
- To provide recommendations for improving ECMO program efficacy.
Main Methods:
- Retrospective review of all infants referred to a single ECMO center over a 52-month period.
- Analysis of referral data, ECMO eligibility, treatment outcomes, and mortality causes.
- Calculation of mortality rates for specific conditions and transport scenarios.
Main Results:
- Of 167 referrals, 158 infants were accepted; 18 died before or shortly after ECMO initiation.
- Sixty-eight infants received ECMO, with a 16.1% mortality rate among them.
- Overall mortality was 27.5%, with 39.1% of deaths linked to transport; congenital diaphragmatic hernia had a 63.6% mortality rate.
Conclusions:
- Early transport, particularly in utero or during the "honeymoon" phase for congenital diaphragmatic hernia, is recommended.
- Expedited transfer for meconium aspiration syndrome at an oxygenation index of 25 may improve outcomes.
- Minimizing transport-related mortality is critical for enhancing ECMO program success and patient survival.
Abstract:
We reviewed the outcome of all infants referred to, and accepted in, our extracorporeal membrane oxygenation (ECMO) program during a 52-month period. One hundred sixty-seven referrals, representing 158 infants and nine mothers who had not yet delivered their infants, were accepted. Eighteen infants (11.3% of all neonates transported) died before leaving the referring hospital, during transport, or shortly after admission to our unit. Contraindications to ECMO excluded 17 (10.1%) of the 167 referrals. Sixty-two infants (37.1%) initially did not meet ECMO criteria. Two died before ECMO could be started. Sixty-eight infants (40.7%) were given ECMO therapy, and 11 died (16.1%). Nine mothers were referred because of fetal conditions that might require ECMO; of these infants, two died during delivery and three had contraindications to the use of ECMO. The four remaining infants were given ECMO therapy; three survived. The overall mortality rate was 27.5% (46/167); 18 (39.1%) of the 46 deaths were associated with transfer. The mortality rate associated with congenital diaphragmatic hernia was 63.6%. We recommend early transport of infants with this type of hernia during the postoperative "honeymoon" or during in utero transport with delivery at an ECMO center. We also recommend that infants with meconium aspiration syndrome be transported to an ECMO center when an oxygenation index of 25 is reached. The mortality rate associated with transport needs to be considered in evaluating ECMO programs. Earlier, expedited transfers may increase the survival rate.