Neonatal extracorporeal life support: Impact of new therapies on survival

Fliman, P.; deRegnier, Raye Ann; Kinsella, John P.; Reynolds, Marleta; Rankin, Linda L.; Steinhorn, Robin H.

doi:10.1016/j.jpeds.2005.12.024

Cited by 56 publications

(37 citation statements)

References 21 publications

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“…Although the cause of this reduction is not clear, it may be assumed that as increasing numbers are rescued by other therapies, the severity and acuity of the patients going on to ECMO has increased. This finding differs from those of Fliman et al, 15 who only looked at cases from 1996 to 2003. This difference in survival data is probably related to the time period studied, with the late 1980s, as depicted in Figure 4, representing the highest survival rate prior to most new interventions.…”

Section: Introductioncontrasting

confidence: 94%

Extracorporeal membrane oxygenation: use in meconium aspiration syndrome

Short

2008

J Perinatol

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Extracorporeal membrane oxygenation (ECMO) has been successful as a rescue therapy for infants with respiratory failure with some diagnoses such as meconium aspiration syndrome (MAS) having a survival rate of more than 94%. New therapies have allowed many infants who would have required ECMO to be kept off ECMO, but at what cost. The survival rate for the neonatal ECMO patient has dropped over the years, whereas the time of ECMO has increased, indicating that the new therapies are keeping the less ill infants off ECMO. The major cause of non-survival in this population remains intraventricular hemorrhage. The primary risk factors related to this are thought to be pre-ECMO events, such as hypoxia and/or ischemia either prenatally or post-delivery. ECMO events that may complicate this are heparinization that is required while on ECMO and concern for the effect of shear stress and blood flow pattern changes created by the ECMO pump with venoarterial ECMO, although these changes are not seen in venovenous ECMO, the more common form of ECMO. Newer low-resistant microporous artificial lungs and miniaturized pumping systems may allow ECMO to be performed using less blood and safer equipment. The smaller low-resistant artificial lungs provide the ability to consider giving extracorporeal life support using only this membrane with flow provided by an arterial-venous shunt, thus eliminating the pumping system all together. Trials are ongoing in adults and, if effective, may direct further research into using this technique in newborns where the umbilical artery and vein could be used as the arterial-venous shunt.

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Section: Introductioncontrasting

confidence: 94%

Extracorporeal membrane oxygenation: use in meconium aspiration syndrome

Short

2008

J Perinatol

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“…It has been shown to improve oxygenation and decrease the need for extra-corporeal membrane oxygenation (ECMO) in neo-nates with severe respiratory failure [26,27].…”

Section: Surfactant Therapymentioning

confidence: 99%

“…HFOV has been used effectively to treat patients with severe respiratory failure, who are being considered for ECMO [27,37]. Combined iNO and HFOV therapy was found to be more effective in rescuing infants with severe PPHN, probably by improving intrapulmonary shunt which favours release of NO in the area of action [38].…”

Section: High-frequency Oscillatory Ventilation (Hfov)mentioning

confidence: 99%

“…ECMO as an option is almost nonexistent in developing countries and even in developed countries; availability is limited to few specialist centres only. Newer therapies including iNO, HFO, and surfactant have significant reduced the need for ECMO in PPHN and it is now mostly limited to iNO non-responders especially CDH with pulmonary hypoplasia [27].…”

Section: Ecmomentioning

confidence: 99%

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Persistent Pulmonary Hypertension of the Newborn: Recent Advances in the Management

Agarwal

2013

Int J Clin Pediatr

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Persistent pulmonary hypertension of the newborn (PPHN) is a medical emergency in the neonatal period, which occurs due to failure of normal postnatal transition of fetal circulation. Despite availability of numerous treatment modalities, associated mortality and morbidity remain high. Therefore, awareness of predisposing conditions, and early diagnosis and management may help improving outcome in PPHN. To provide an overview of anatomic and functional anomalies of PPHN, and available treatment options with special focus on recent advances in the diagnosis and management of this potentially lethal illness. MEDLINE, EMBASE, The Cochrane Library, and Google Scholar databases were searched (inception until Nov-2012) using terms "persistent pulmonary hypertension of newborn", "hypoxemic respiratory failure", "nitric oxide", "sildenafil", "milrinone" and "prostacyclin" without any language restriction. www.clinicaltrials.gov website was searched for relevant ongoing trials. Additionally, manual review of article bibliographies was done for potentially relevant studies. Strategies for the management of PPHN are undergoing metamorphosis. Gentle ventilation and high-frequency ventilation have replaced prior hyperventilation strategy. Currently, iNO is the only FDA-approved selective pulmonary vasodilator for infants with hypoxemic respiratory failure/PPHN; however, it has poor/no response in upto 30% cases. Recent studies have provided evidences for the use of other therapeutic agents such as PDE-inhibitors, magnesium sulphate and prostacyclin analogues. Finally, recent laboratory studies have demonstrated the role of oxidant stress as well as potential use of free radical scavengers for example, superoxide dismutase and catalase in the management of PPHN. Assisted ventilation and pharmacologic manipulation are the mainstays of treatment of PPHN. Limited availability of the gold standard treatment option namely iNO, especially in resource-limited countries, leads to increasing use of alternative therapeutic options such as PDE-inhibitors (sildenafil and milrinone). However, as any single therapy can not be labelled as a magic bullet for PPHN, further clinical trials are required to demonstrate the efficacy and safety of available therapeutic options as well as to develop newer strategies targeted to the underlying pathophysiology.

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“…1 In the early 1990s the use of ECMO in newborns began to decline with the introduction of high-frequency oscillatory ventilation, and continued to decline with the availability of surfactant replacement therapy and inhaled nitric oxide. 2 As a result of these advancements the treatment algorithm for respiratory failure in newborns was recalibrated, with ECMO used more in a rescue manner.…”

mentioning

confidence: 99%

Are Contraindications to Extracorporeal Membrane Oxygenation Slowly Vanishing?

Betit

2011

Respir Care

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Neonatal extracorporeal life support: Impact of new therapies on survival

Cited by 56 publications

References 21 publications

Extracorporeal membrane oxygenation: use in meconium aspiration syndrome

Extracorporeal membrane oxygenation: use in meconium aspiration syndrome

Persistent Pulmonary Hypertension of the Newborn: Recent Advances in the Management

Are Contraindications to Extracorporeal Membrane Oxygenation Slowly Vanishing?

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