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ECMO for premature neonates- Are we there yet?
Carmen Mesas Burgos1, Natalie Rintoul2, Lars Mikael Broman3
1Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden; ECMO Centre Karolinska, Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Stockholm, Sweden.
Extracorporeal membrane oxygenation (ECMO) may be viable for premature infants (32-33 weeks gestation) in specialized centers. Technological advancements have reduced risks like intracranial bleeding, challenging current guidelines.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Critical Care
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-saving support for newborns.
- Prematurity and low birth weight are considered contraindications due to bleeding risks.
- Outcomes for preterm infants on ECMO have improved, with decreased intracranial bleeding.
Purpose of the Study:
- To evaluate the potential for using ECMO in preterm infants (32-33 weeks gestation).
- To challenge current Extracorporeal Life Support Organization (ELSO) guidelines that restrict ECMO for these infants.
- To propose criteria for safe implementation of Prem-ECMO.
Main Methods:
- Review of outcomes in neonatal ECMO, focusing on preterm infants.
- Analysis of technological advancements and their impact on safety.
- Comparison of current ELSO guidelines with emerging evidence.
Main Results:
- Morbidity, particularly intracranial bleeding, has decreased in preterm infants undergoing ECMO.
- Technological developments have improved ECMO safety and efficacy.
- Current ELSO guidelines may be overly restrictive.
Conclusions:
- Prem-ECMO (gestational age 32-33 weeks) could be considered in experienced, high-volume neonatal centers.
- Close monitoring, rigorous reporting, and targeted oxygen delivery are crucial.
- Continuous development of ECMO technology for neonates is essential.
