Do we need new indications for ECMO in neonates pretreated with high-frequency ventilation and/or inhaled nitric oxide?

Kössel, Hans; Bauer, Karl; Kewitz, G; Karaca, Saffet; Versmold, Hans T.

doi:10.1007/s001340000603

Cited by 26 publications

(6 citation statements)

References 11 publications

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“…We consider it more likely that the reduction in OI reflects the increased use of iNO and HFOV, and that the babies needing ECMO support in the current era, were in fact sicker than those needing ECMO 10 years ago. Indeed some authors have suggested that the improvement in oxygenation observed with iNO should be used as a window for safer ECMO cannulation and that neonates treated with HFOV and iNO should be considered for ECMO at a lower OI than those treated conventionally 9 14…”

Section: Discussionmentioning

confidence: 99%

Neonatal extracorporeal membrane oxygenation: practice patterns and predictors of outcome in the UK

Karimova

Brown

Ridout

et al. 2009

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Section: Discussionmentioning

confidence: 99%

Neonatal extracorporeal membrane oxygenation: practice patterns and predictors of outcome in the UK

Karimova

Brown

Ridout

et al. 2009

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…The oxygenation index and other severity of illness criteria are limited in their ability to predict mortality, 9 particularly as the non-ECMO management of neonates with respiratory failure has evolved. These severity of illness criteria for ECMO may need to be updated, 10, 11, 12, 13 particularly for neonates with CDH, 14, 15, 16 but at the moment are fairly well standardized.…”

Section: Discussionmentioning

confidence: 99%

Patient selection for neonatal extracorporeal membrane oxygenation: beyond severity of illness

et al. 2009

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Objective:To explore how neonates with respiratory failure are selected for extracorporeal membrane oxygenation (ECMO) once severity of illness criteria are met, and to determine how conflicts between ECMO providers and parents over the initiation of ECMO are addressed.Study Design:A cross-sectional study was conducted using a data collection survey, which was sent to the directors of neonatal respiratory ECMO centers.Result:The lowest birth weight and gestational age at which respondents would consider placing a neonate on ECMO were frequently below recommended thresholds. There was wide variability in respondents' willingness to place neonates on ECMO in the presence of conditions such as intraventricular hemorrhage and hypoxic ischemic encephalopathy. The number of respondents who would never seek to override parental refusal of ECMO was equal to the number who would always do so.Conclusion:Significant variability exists in the selection criteria for neonatal ECMO and in how conflicts with parents over the provision of ECMO are resolved.

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“…In the UK trial, the control group had a mortality rate, depending on the underlying disease, of 43% in meconium aspiration syndrome to 100% in congenital diaphragmatic hernia. To avoid a delay in the use of ECMO because of an inadequate response to prior iNO treatment and other techniques like HFO, it has been suggested to lower the current ECMO criteria in patients suffering from severe hypoxic respiratory failure, who are already treated with iNO and HFO ventilation [2,9]. Schumacher et al [10] showed a shorter length of hospitalization, better cost-effectiveness and better (neurological) outcome at 1 year of age when neonates were randomized to lower threshold criteria to initiate ECMO.…”

Section: Cerebral Aspects Related To Neonatal Ecmomentioning

confidence: 99%

Cerebral Aspects of Neonatal Extracorporeal Membrane Oxygenation: A Review

2013

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Background: Neonatal extracorporeal membrane oxygenation (ECMO) is a lifesaving therapeutic approach in newborns suffering from severe, but potentially reversible, respiratory insufficiency, mostly complicated by neonatal persistent pulmonary hypertension. However, cerebral damage, intracerebral hemorrhage as well as ischemia belong to the most devastating complications of ECMO. Objectives: The objectives are to give insights into what is known from the literature concerning cerebral damage related to neonatal ECMO treatment for pulmonary reasons. Methods: A short introduction to ECMO indications and technical aspects of ECMO are provided for a better understanding of the process. The remainder of this review focuses on outcome and especially on (potential) risk factors for cerebral hemorrhage and ischemia during ECMO treatment. Results: Although neonatal ECMO treatment shows improved outcome compared to conservative treatment in cases of severe respiratory insufficiency, it is related to disturbances in various aspects of neurodevelopmental outcome. Risk factors for cerebral damage are either related to the patient's disease, EMCO treatment itself, or a combination of both. Conclusion: It is of ongoing importance to further understand pathophysiological mechanisms resulting in cerebral hemorrhage and ischemia due to ECMO and to develop neuroprotective strategies and approaches.

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Do we need new indications for ECMO in neonates pretreated with high-frequency ventilation and/or inhaled nitric oxide?

Abstract: For neonates pretreated with HFV/iNO, an OI > 40 is an inadequate ECMO indication. Based on our data we hypothesize that an OI > or = 25 after 72 h of HFV/ iNO is a better ECMO indication that avoids prolonged barotrauma.

Cited by 26 publications

References 11 publications

Neonatal extracorporeal membrane oxygenation: practice patterns and predictors of outcome in the UK

Neonatal extracorporeal membrane oxygenation: practice patterns and predictors of outcome in the UK

Patient selection for neonatal extracorporeal membrane oxygenation: beyond severity of illness

Cerebral Aspects of Neonatal Extracorporeal Membrane Oxygenation: A Review

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