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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.
The Journal of Pediatrics
|September 1, 1990
Summary
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.