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Historical controls for extracorporeal membrane oxygenation in neonates
1Department of Pediatrics, Naval Hospital, Bethesda, MD 20814-5011.
Critical Care Medicine
|May 1, 1989
Summary
Extracorporeal membrane oxygenation (ECMO) criteria were met by five infants, all of whom survived with conventional therapy. This challenges historical mortality rates and supports the need for controlled trials.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Cardiopulmonary Support
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support technology for neonates with severe respiratory failure.
- Established criteria for ECMO use were developed based on historical mortality rates.
Observation:
- A retrospective review identified five infants meeting Loe's criteria for ECMO between 1983-1985.
- All infants had persistent pulmonary hypertension, with two also having hyaline membrane disease and one with asphyxia/meconium aspiration.
- These infants, all weighing over 2 kg, met criteria based on alveolar-arterial oxygen pressure difference (P[A-a]O2) and/or barotrauma.
Findings:
- All five infants survived after receiving conventional therapy, resulting in a 0% mortality rate in this cohort.
- This contrasts sharply with estimated control group mortality rates of 80-94% for similar cases.
- No patients meeting ECMO criteria died, and none were referred for ECMO during the study period.
Implications:
- The study suggests that historical mortality rates used to justify ECMO may no longer be accurate.
- The findings support the ethical imperative for conducting controlled trials of ECMO in eligible neonates.
- This research highlights the potential effectiveness of conventional therapy in select cases, warranting further investigation.