Alveolar-Arterial oxygen gradients versus the neonatal pulmonary insufficiency index for prediction of mortality in ECMO candidates

Krummel, Thomas M.; Greenfield, Lazar J.; Kirkpatrick, Barry V.; Mueller, Dawn G.; Kerkering, Kathryn W.; Ormazabal, Miguel; Napolitano, Anthony; Salzberg, A.M.

doi:10.1016/s0022-3468(84)80257-2

Cited by 76 publications

(11 citation statements)

References 10 publications

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“…In the United States the incidence of PPH varies between 0.07 and 2.3% of live births, accounting for ϳ1% of admissions to neonatal intensive care units (42). Despite aggressive management with hyperventilation, fluids, and vasodilators, mortality is as high as 34-60% (1,9,10,21). These lung disorders together constitute a group in great need of further understanding of the mechanism(s) associated with pulmonary hypertension (PH) and subsequent development of effective treatment.…”

mentioning

confidence: 99%

Three-week neonatal hypoxia reduces blood CGRP and causes persistent pulmonary hypertension in rats

Keith

Tjen‐A‐Looi

Kraiczi³

et al. 2000

American Journal of Physiology-Heart and Circulatory Physiology

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To increase understanding of persistent pulmonary hypertension, we examined chronic pulmonary effects of hypoxia at birth and their relationships with immunoreactive levels of the potent vasodilator, calcitonin gene-related peptide (CGRP). Rats were born in 10% hypobaric hypoxia, where they remained for 1-2 days, or in 15% hypoxia, where they remained for 21 days. All were then reared in normoxia for 3 mo followed by reexposure to 10% hypoxia for 7 days (H-->H) or continued normoxia (H-->N); age-matched normoxic rats were hypoxic for the last 7 days (N-->H) or normoxic throughout (N-->N). Results are as follows. Pulmonary arterial pressure (P(PA)) in 10% H-->N rats was normal at the end of the experiment (13 wk), but in rats reexposed to hypoxia (H-->H), pressure rose to 19% above N-->H controls. In 15% H-->N rats, P(PA) remained high, similar to that of N-->H rats, and increased further by 40% on reexposure (H-->H). Medial thickness of small pulmonary arteries in 10% H-->H rats also increased by 40% over N-->H controls and was equally high in 15% H-->N and H-->H rats. In N-->H rats from both experiments, right ventricular hypertrophy index (RVH) was increased after hypoxia at 15-16 wk. Also, in the 15% study, RVH remained elevated in H-->N rats and increased in H-->H rats by 19% above N-->H controls. Blood CGRP was reduced by neonate and adult hypoxia, and hypoxic reexposure (H-->H) further lowered blood CGRP in the 15% but not 10% study. Declining left ventricular blood CGRP correlated highly with logarithmically increasing P(PA) in the 15% study (r = -0.81, P = 0.000). In conclusion, 1) short perinatal exposure to 10% O(2) exacerbated pulmonary hypertension with hypoxia later in life, 2) 15% O(2) at birth and for 21 days caused persistent pulmonary hypertension and exacerbation with reexposure, and 3) P(PA) correlated highly with declining blood CGRP levels in the 15% study.

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confidence: 99%

Three-week neonatal hypoxia reduces blood CGRP and causes persistent pulmonary hypertension in rats

Keith

Tjen‐A‐Looi

Kraiczi³

et al. 2000

American Journal of Physiology-Heart and Circulatory Physiology

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“…Since then, many doctors in the United States (3,(8)(9)(10)(14)(15)(16) have employed ECMO to manage the neonates with not only CDH but other respiratory failures such as meconium aspiration. Bartlett and coworkers (13) have also proposed the neonatal ECMO registry 10 collect data and to evaluate the efficacy of ECMO.…”

Section: Discussionmentioning

confidence: 99%

Management of Congenital Diaphragmatic Hernia by Extracorporeal Membrane Oxygenation (ECMO)

Nagaya

Tsuda²,

Murahashi³

et al. 1991

Eur J Pediatr Surg

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The purpose of this study was to evaluate the efficacy of extracorporeal membrane oxygenation (ECMO) for patients with congenital diaphragmatic hernia (CDH). Ten patients whose mortality was predicted to be more than 80% with previous therapeutics, were selected to use ECMO over the past five years. Patients were placed on ECMO by cannulating the right jugular vein and the right carotid artery. ECMO was started at 34.3 hours after birth on an average, and the average time on ECMO was 96.3 hours. Seven patients (70%) survived, and six out of them are in good health without any sequelae. In particular, all five patients whose pathological condition needing ECMO was persistent fetal circulation (PFC), survived. Therefore we believe ECMO is highly beneficial to overcome the condition of PFC. The survival rate of CDH patients under 24 hours of age in our hospital is 76.2% (16/21 cases) over the last 5 years, and it has improved compared with 57.1% (12/21 cases) before then. The fact that some of the critical patients who were lethal with conventional management, have been successfully treated by ECMO, played a great role in this improvement.

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“…Within a few years, additional studies substantiated the use of the Aa gradient in predicting mortality, further refining its predictive value. 23,24 Along with mean airway pressure, the Aa gradient soon thereafter was incorporated into a third predictive model, the oxygenation index (OI), 25 and today these 2 calculated values are the principal ECMO entry criteria for neonates with respiratory failure (Table 1). 26 Despite the fact that there is general acceptance of these entry criteria, however, it remains exceedingly difficult, perhaps impossible, even to define what is optimal pre-ECMO care for these newbornsor to determine when it has failed.…”

Section: Determining Failure Of Conventional Therapymentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for the Treatment of Neonatal Respiratory Failure

Carey

Colby

2009

Semin Cardiothorac Vasc Anesth

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This review discusses the use of extracorporeal membrane oxygenation (ECMO) for the treatment of respiratory failure in neonates. After briefly reviewing the early history of neonatal ECMO, the authors describe the respiratory diagnoses most often treated with ECMO and the manner in which affected neonates are deemed to have "failed" conventional therapies and thus require ECMO. After reviewing the most common indications for ECMO, factors that influence the timing of conversion to extracorporeal life support, as well as criteria that may exclude patients from receiving ECMO therapy, are described. At the conclusion of this article, the authors discuss the long-term outcomes of neonates whose respiratory disease was treated with ECMO and the costs associated with that care.

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Alveolar-Arterial oxygen gradients versus the neonatal pulmonary insufficiency index for prediction of mortality in ECMO candidates

Cited by 76 publications

References 10 publications

Three-week neonatal hypoxia reduces blood CGRP and causes persistent pulmonary hypertension in rats

Three-week neonatal hypoxia reduces blood CGRP and causes persistent pulmonary hypertension in rats

Management of Congenital Diaphragmatic Hernia by Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation for the Treatment of Neonatal Respiratory Failure

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