ECMO: regional evaluation of need and applicability of selection criteria

The need and indications for neonatal extracorporeal membrane oxygenation (ECMO) are controversial. The need for ECMO in two New England states was studied through a review of deaths due to respiratory failure in near- and full-term infants. Vermont averaged 2.4 and Maine averaged 7.4 deaths annually. Neither state demonstrated sufficient respiratory deaths to establish ECMO capability. The number of "potential" ECMO candidates, based on published selection criteria, was studied, and the applicability of criteria was evaluated. A two-year review revealed 16 potential candidates from Maine and 19 from Vermont. No criterion accurately identified nonsurvivors of conventional ventilatory therapy. Only one criterion in one institution demonstrated an association with chronic lung disease. The data demonstrated that published ECMO selection criteria were not applicable in different populations.