Semin Thorac Cardiovasc Surg. 2020 Feb 26. pii: S1043-0679(20)30036-8. doi: 10.1053/j.semtcvs.2020.02.021. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/32112973
EXTRA-CORPOREAL MEMBRANE OXYGENATION FOR NEONATAL RESPIRATORY SUPPORT.
Corno AF1, Faulkner GM2, Harvey C2.
To review our experience with Extra-Corporeal Membrane Oxygenation (ECMO) for respiratory support in neonates. From 1989 to 2018 2,114 patients underwent respiratory ECMO support, with 764(36%) neonates. Veno-Venous (V-V) cannulation was used in 428(56%) neonates and Veno-Arterial (V-A) in 336(44%). Historically V-V ECMO was our preferred modality, but due to lack of suitable cannula in the last 7 years V-A was used in 209/228(92%) neonates. Mean and IQR of ECMO duration was 117 hours (IQR 90 to 164 hours). Overall 724(95%) neonates survived to ECMO decannulation, with 640(84%) hospital discharge. Survival varied with underlying diagnosis: meconium aspiration 98%(354/362), persistent pulmonary hypertension 80%(120/151), congenital diaphragmatic hernia 66%(82/124), sepsis 59%(35/59), pneumonia 86%(6/7), other 71%(43/61). Survival was 86% with V-V and 80% with V-A cannulation, better than ELSO Registry with 77% V-V and 63% V-A. Major complications: cerebral infarction/hemorrhage in 4.7% (31.1% survival to discharge), renal replacement therapy in 17.6% (58.1% survival to discharge), new infection in 2.9%, with negative impact on survival (30%). Following a circuit design modification and subsequent reduction in heparin requirement, intra-cerebral hemorrhage decreased to 9/299(3.0%) radiologically proven cerebral infarction/hemorrhage. outcomes from neonatal ECMO in our large case series were excellent, with better survival and lower complication rate than reported in ELSO registry. A) these results highlight the benefits of ECMO service in high volume units. B) the similar survival rate seen in neonates with V-A and V-V cannulation differs from the ELSO register; this may reflect the change in cannulation enforced by lack of suitable V-V cannula and all neonates undergoing V-A cannulation ULTRAMINI ABSTRACT Sevenhundred-sixtyfour neonates underwent respiratory ECMO, with 95% surviving decannulation, and 84% hospital discharge. Survival varied with diagnosis: meconium aspiration 98%, pneumonia 86%, pulmonary hypertension 80%, diaphragmatic hernia 66%, sepsis 59%. Complications: cerebral infarction/hemorrhage (4.7%), renal replacement therapy (17.6%), infection (2.9%). Excellent outcomes highlight the benefits of high volume ECMO units.
Copyright © 2020. Published by Elsevier Inc.
Congenital diaphragmatic hernia; ECMO; Meconium aspiration; Neonatal ECMO; Primitive pulmonary hypertension; Respiratory assistancePMID: 32112973 DOI: 10.1053/j.semtcvs.2020.02.021