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Extracorporeal membrane oxygenation as treatment of severe meconium aspiration syndrome
E D Graves1, W A Loe, C R Redmond
1Department of Surgery, Ochsner Clinic, New Orleans, LA 70121.
Abstract:
Meconium aspiration syndrome (MAS) is a common cause of morbidity and mortality in neonates. Chemical pneumonitis can lead to persistent pulmonary hypertension of the newborn (PPHN) with irreversible hypoxia and death. Extracorporeal membrane oxygenation (ECMO) for the treatment of severe PPHN became available at the Ochsner Foundation Hospital in September 1983. We reviewed the first 28 cases in which ECMO was used for the treatment of PPHN due to severe MAS; 26 of the 28 infants survived. During the three years preceding our development of ECMO capability, ten neonates had PPHN due to severe MAS and met the criteria for ECMO; only three survived. The difference in survival demonstrates the efficacy of ECMO for the treatment of severe MAS. We believe that when established criteria are met, ECMO should be instituted without delay.
Insights
Extracorporeal membrane oxygenation (ECMO) significantly improves survival rates for neonates suffering from severe meconium aspiration syndrome (MAS)-induced persistent pulmonary hypertension. This life-saving treatment offers a critical intervention for infants facing irreversible hypoxia and potential death.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Cardiopulmonary Support
Background:
- Meconium aspiration syndrome (MAS) is a primary cause of neonatal morbidity and mortality.
- MAS can lead to persistent pulmonary hypertension of the newborn (PPHN), resulting in irreversible hypoxia and death.
- Severe PPHN necessitates advanced respiratory and circulatory support.
Purpose of the Study:
- To evaluate the efficacy of extracorporeal membrane oxygenation (ECMO) in treating PPHN secondary to severe MAS.
- To compare survival rates before and after the implementation of ECMO for this condition.
Main Methods:
- Retrospective review of the first 28 neonates treated with ECMO for PPHN due to severe MAS.
- Comparison of survival data with a cohort of 10 neonates with similar conditions treated in the preceding three years.
Main Results:
- A survival rate of 26 out of 28 infants (93%) was achieved with ECMO treatment.
- In the pre-ECMO era, only 3 out of 10 infants (30%) with similar criteria survived.
Conclusions:
- ECMO demonstrates significant efficacy in improving survival for neonates with severe MAS-induced PPHN.
- Prompt initiation of ECMO, once established criteria are met, is crucial for optimal outcomes.