Neonatal Extracorporeal Membrane Oxygenation Due to Respiratory Failure: A Single Center Experience Over 28 Years

Reiterer, F; Resch, Elisabeth; Haim, Michaela; Maurer-Fellbaum, U.; Riccabona, Michael; Zobel, G; Urlesberger, Berndt; Resch, Bernhard

doi:10.3389/fped.2018.00263

Cited by 24 publications

(14 citation statements)

References 20 publications

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“…Historically, meconium aspiration syndrome, PPHN, and neonatal respiratory distress syndrome were the most common ECMO indications in the neonatal period. Their incidence has recently declined due to perinatal care improvement [12,[14][15][16][17][33][34][35][36]. The use of ECMO for pneumonia and neonatal sepsis has also declined.…”

Section: Neonatal Respiratory Indicationsmentioning

confidence: 99%

Neonatal respiratory and cardiac ECMO in Europe

et al. 2021

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Neonatal extracorporeal membrane oxygenation (ECMO) is a life-saving procedure for critically ill neonates suffering from a potentially reversible disease, causing severe cardiac and/or respiratory failure and refractory to maximal conventional management. Since the 1970s, technology, management, and clinical applications of neonatal ECMO have changed. Pulmonary diseases still represent the principal neonatal diagnosis, with an overall 74% survival rate, and up to one-third of cases are due to congenital diaphragmatic hernia. The overall survival rate in cardiac ECMO is lower, with congenital heart defect representing the main indication. This review provides an overview of the available evidence in the field of neonatal ECMO. We will address the changing epidemiology, basic principles, technologic advances in circuitry, and monitoring, and deliver a current multidisciplinary management framework, focusing on ECMO applications, complications, and long-term morbidities. Lastly, areas for further research will be highlighted. Conclusions : ECMO is a life support with a potential impact on long-term patients’ outcomes. In the next years, advances in knowledge, technology, and expertise may push neonatal ECMO boundaries towards more premature and increasingly complex infants, with the final aim to reduce the burden of ECMO-related complications and improve overall patients’ outcomes. What is Known: • ECMO is a life-saving option in newborns with refractory respiratory and/or cardiac failure. • The multidisciplinary ECMO management is challenging and may expose neonates to complications with an impact on long-term outcomes. What is New: • Advances in technology and biomaterials will improve neonatal ECMO management and, eventually, the long-term outcome of these complex patients. • Experimental models of artificial placenta and womb technology are under investigation and may provide clinical translation and future research opportunities.

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Section: Neonatal Respiratory Indicationsmentioning

confidence: 99%

Neonatal respiratory and cardiac ECMO in Europe

et al. 2021

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“…In future, more attention should be directed to short and long-term morbidity. ECMO centers may reflect not only their survival rate, but also changes in indications for ECMO and cognitive impairment as the major long-term deficit following neonatal ECMO (54). The most important issue after ECMO in CDH is neurodevelopment outcome.…”

Section: Improving Long-term Outcome Of Cdh Via Structured Follow Upmentioning

confidence: 99%

“…For long-term evaluation, MRI including angiography seems to be helpful for reflection of the initial decisions and may help to relate the results to the complications (40). Intelligence, memory, attention, behavior, and concentration deficits are domains of interest in school age (54–57).…”

Section: Improving Long-term Outcome Of Cdh Via Structured Follow Upmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia

Rafat

Schaible

2019

Front. Pediatr.

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Congenital diaphragmatic hernia (CDH) is characterized by failure of diaphragmatic development with lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). If conventional treatment with gentle ventilation and optimized vasoactive medication fails, extracorporeal membrane oxygenation (ECMO) may be considered. The benefits of ECMO in CDH are still controversial, since there are only few randomized trials demonstrating the advantages of this therapeutic option. At present, there is no precise prenatal and/or early postnatal prognostication parameter to predict reversibility of PPHN in CDH patients. Indications for initiating ECMO include either respiratory or circulatory parameters, which are also undergoing continuous refinement. Centers with higher case numbers and the availability of ECMO published promising survival rates, but data on long-term results, including morbidity and quality of life, are rare. Survival might be influenced by the timing of ECMO initiation and the timing of surgical repair. In this regard a trend toward early initiation of ECMO and early surgery on ECMO exists. The results concerning the cannulation modes are similar and a consensus on time limit for ECMO runs does not exist. The use of ECMO in CDH will continue to be evaluated, and prospective randomized trials and registry network are necessary to help answering the addressed questions of patient selection and management.

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“…Multiple organ dysfunction syndrome (MODS), defined as the presence of at least one organ dysfunction in addition to HIE, occurred in 58–88% of asphyxiated neonates (33) and contributed to higher mortality rates (20.5–72.9%) (31). MODS may complicate the course of neonatal ECMO, with a negative impact on survival (34, 35). Moreover, after out of hospital pediatric cardiac arrest, AKI is very common (64% of the enrolled cases, n = 282), and severe (41% of the enrolled cases), without difference in incidence in severe AKI between cases that either or not underwent HT (36).…”

Section: The Role Of Non-maturational Determinants On Drug Dispositiomentioning

confidence: 99%

Drug Disposition and Pharmacotherapy in Neonatal ECMO: From Fragmented Data to Integrated Knowledge

et al. 2019

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Extracorporeal membrane oxygenation (ECMO) is a lifesaving support technology for potentially reversible neonatal cardiac and/or respiratory failure. As the survival and the overall outcome of patients rely on the treatment and reversal of the underlying disease, effective and preferentially evidence-based pharmacotherapy is crucial to target recovery. Currently limited data exist to support the clinicians in their every-day intensive care prescribing practice with the contemporary ECMO technology. Indeed, drug dosing to optimize pharmacotherapy during neonatal ECMO is a major challenge. The impact of the maturational changes of the organ function on both pharmacokinetics (PK) and pharmacodynamics (PD) has been widely established over the last decades. Next to the developmental pharmacology, additional non-maturational factors have been recognized as key-determinants of PK/PD variability. The dynamically changing state of critical illness during the ECMO course impairs the achievement of optimal drug exposure, as a result of single or multi-organ failure, capillary leak, altered protein binding, and sometimes a hyperdynamic state, with a variable effect on both the volume of distribution (Vd) and the clearance (Cl) of drugs. Extracorporeal membrane oxygenation introduces further PK/PD perturbation due to drug sequestration and hemodilution, thus increasing the Vd and clearance (sequestration). Drug disposition depends on the characteristics of the compounds (hydrophilic vs. lipophilic, protein binding), patients (age, comorbidities, surgery, co-medications, genetic variations), and circuits (roller vs. centrifugal-based systems; silicone vs. hollow-fiber oxygenators; renal replacement therapy). Based on the potential combination of the above-mentioned drug PK/PD determinants, an integrated approach in clinical drug prescription is pivotal to limit the risks of over- and under-dosing. The understanding of the dose-exposure-response relationship in critically-ill neonates on ECMO will enable the optimization of dosing strategies to ensure safety and efficacy for the individual patient. Next to in vitro and clinical PK data collection, physiologically-based pharmacokinetic modeling (PBPK) are emerging as alternative approaches to provide bedside dosing guidance. This article provides an overview of the available evidence in the field of neonatal pharmacology during ECMO. We will identify the main determinants of altered PK and PD, elaborate on evidence-based recommendations on pharmacotherapy and highlight areas for further research.

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Neonatal Extracorporeal Membrane Oxygenation Due to Respiratory Failure: A Single Center Experience Over 28 Years

Cited by 24 publications

References 20 publications

Neonatal respiratory and cardiac ECMO in Europe

Neonatal respiratory and cardiac ECMO in Europe

Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia

Drug Disposition and Pharmacotherapy in Neonatal ECMO: From Fragmented Data to Integrated Knowledge

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