The Annals of Thoracic Surgery, Vol 50, 720-723, Copyright © 1990 by The Society of Thoracic Surgeons
Prognostic determinants in extracorporeal membrane oxygenation for respiratory failure in newborns
TR Weber, RH Connors, TF Tracy Jr, PV Bailey, C Stephens and W Keenan
St. Louis University School of Medicine, Missouri.
Extracorporeal membrane oxygenation (ECMO) is becoming an accepted
therapeutic modality for newborn respiratory failure, but there is little
information available regarding the prognostic determinants with this
technique. One hundred thirty-five newborns treated with ECMO over a 4-year
period were critically analyzed with regard to the influence that birth
weight, gestational age, age at initiation of ECMO, best blood gases before
ECMO, number of hours on ECMO, renal failure, intracerebral hemorrhage, and
long-distance air transport had on survival. Infants with meconium
aspiration and those undergoing long- distance transfer showed significant
differences in blood gases before ECMO, with survivors having more normal
pH and carbon dioxide tension values. Intracerebral hemorrhage and renal
failure that developed during ECMO were grave prognostic signs, with few
survivors in either group. These data show that ability to ventilate
patients before ECMO, giving normal carbon dioxide tension and pH values,
is an important prognostic sign in infants with meconium aspiration and
undergoing long- distance transfer for ECMO, whereas renal failure and
intracerebral hemorrhage are usually lethal complications of ECMO. Each
center performing ECMO should continually reevaluate this invasive
technique and its results and complications.