Neonatal respiratory extracorporeal membrane oxygenation and primary diagnosis: trends between two decades

Sharma, Jotishna; Sherman, Ashley; Rimal, Anisha; Haney, Barb; Weiner, Julie; Pallotto, Eugenia K.

doi:10.1038/s41372-019-0547-y

Cited by 10 publications

(4 citation statements)

References 41 publications

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“…Gestational age (< 34 weeks) and low body weight (< 2000 g) have been associated with high rates of intracranial hemorrhage and mortality [20,[25][26][27][28][29][30]. Currently, the neonatal ECMO population is more critically ill than in the past, making patients' management and cost-benefit assessment more challenging [9,31]. However, there is wide center-to-center heterogeneity in the lower gestational age limits, based on the local level of expertise [28,32].…”

Section: Ecmo Criteria In Neonatesmentioning

confidence: 99%

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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: Ecmo Criteria In Neonatesmentioning

confidence: 99%

“…Notably, also neonatal respiratory ECMO duration is associated with poor outcome. Prolonged respiratory ECMO > 21 days has reported a survival of 23.5% [9].…”

Section: Ecmo For Neonatal Cardiac Failurementioning

confidence: 99%

Neonatal respiratory and cardiac ECMO in Europe

et al. 2021

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“…Improvements in medical management with strategies such as high-frequency ventilation, pulmonary surfactant, and inhaled nitric oxide have led to a decrease in the number of neonates requiring ECMO because of respiratory failure (8-10). However, severe respiratory distress syndrome (11)(12)(13)(14) remains the primary indication for neonatal ECMO.…”

Section: Introductionmentioning

confidence: 99%

Neonatal ECMO in Severe Bronchiolitis: Our Experience in the Last 10 Years.

Merino-Hernández,

Muñoz-Cutillas,

Zeballos-Sarrato

et al. 2024

Preprint

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Introduction: Bronchiolitis is the most common lower respiratory tract infection in infants less than 1 year of age, and the leading cause of hospitalization in this age group in developed countries. Neonates with bronchiolitis usually have a favorable prognosis, but preterm infants due their immaturity sometimes they undergo progressive and rapid deterioration with failure of the standard respiratory support and may require rescue treatment with extracorporeal membrane oxygenation (ECMO). Materials and Methods Observational, retrospective and single-center study conducted in the neonatology department of a high-complexity hospital (Level IIIC). The study included patients admitted to the Neonatal Intensive Care Unit who required ECMO for severe respiratory failure due to acute bronchiolitis between 2013 and 2022. Results 6 patients were included, 83.3% preterm with a median gestational age of 28.6 weeks (IQR 27.1–29.6)). 3 patients (50%) presented with community bronchiolitis, and 3 (50%) with nosocomial bronchiolitis. RSV was isolated in 4 patients, rhinovirus in one and influenza A in another. The median duration of mechanical ventilation before ECMO was 2.5 days (IQR 1–4). At the beginning of ECMO support, the median age was 48.5 days (IQR 34–120), with a median postmenstrual age of 38 weeks (IQR 35-41.8) and a median weight of 2490 grams (IQR 1800–2900). The median duration of ECMO therapy was 14 days (IQR 9–24). 2 patients (33%) died, one from cardiac arrest due to hemopericardium and the other from liver failure with severe coagulopathy. All surviving patients were followed up by pulmonology and neurology. 2 (33.3%) required home oxygen therapy, and both had a respiratory admission in the first year of life. One required bronchodilator treatment, and the other has had a good evolution. One patient was diagnosed with attention deficit hyperactivity disorder, one with autism spectrum disorder and another with mild cognitive retardation and deafness. Conclusion Small infants are at high risk of developing severe bronchiolitis. Although they usually have good outcomes, some cases with the most severe respiratory failure may require rescue treatment with ECMO. When ECMO was needed, an increased mortality rate of 33% was observed, and it was associated with RSV-Bronchiolitis, prematurity, and prolonged ECMO .

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“…Today, congenital diaphragmatic hernia (CDH) and meconium aspiration syndrome (MAS) are the exclusive neonatal diagnoses that alone represent about 46% of all cases of neonatal respiratory ECMO, reaching 92% of total ECMO if all “others” neonatal ECMO were added ( 2 , 3 ). The classification of “others” includes all other diagnostic categories such as non-specific respiratory failure, congenital anomaly, pulmonary hypoplasia, hypoxic-ischemic encephalopathy, cardiorespiratory arrest, and inborn errors of metabolism ( 4 ). The mortality rate, however, varies significantly depending on the underlying respiratory disease.…”

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confidence: 99%

Editorial: Neonatal ECMO in 2019: Where Are We Now? Where Next?

et al. 2022

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Editorial on the Research TopicNeonatal ECMO in 2019: Where Are We Now? Where Next? Despite significant advances in neonatal intensive care, including neonatal ventilation in the current era, extracorporeal membrane oxygenation (ECMO) continues to play a crucial role in selected cases of severe cardio-respiratory failure, potentially reversible, but refractory to conventional ventilatory therapy and maximal pharmacological treatment (1).Our Research Topic attempted to focus on some of continuing challenges in neonatal ECMO. In this issue of Frontiers in Pediatrics, we have collected a wide range of manuscripts related to the use of ECMO in the neonatal period (Broman; Butt and Chiletti; Cashen et al.; Di Nardo et al.; Kersten et al.; Macchini et al.; Perez Ortiz et al.; Rafat and Schaible; Raffaeli et al.; Raffaeli et al.; Roeleveld and Mendonca; Schiller and Tibboel).Since the formation of the Extracorporeal Life Support Organization (ELSO) in 1989, 45,205 newborns have been supported on ECMO in 492 centers (www.elso.org) (2). Respiratory failure was the predominant reason for ECMO utilization in 33,400 newborns, whereas ECMO was used for cardiac failure in 9,561 newborns, and 2,244 were supported for refractory cardiac arrest-extracorporeal cardiopulmonary resuscitation (ECPR). Today, congenital diaphragmatic hernia (CDH) and meconium aspiration syndrome (MAS) are the exclusive neonatal diagnoses that alone represent about 46% of all cases of neonatal respiratory ECMO, reaching 92% of total ECMO if all "others" neonatal ECMO were added (2, 3). The classification of "others" includes all other diagnostic categories such as non-specific respiratory failure, congenital anomaly, pulmonary hypoplasia, hypoxic-ischemic encephalopathy, cardiorespiratory arrest, and inborn errors of metabolism (4). The mortality rate, however, varies significantly depending on the underlying respiratory disease. For instance, neonates with CDH and sepsis have higher mortality rates (47 and 49%, respectively) in contrast to those with MAS (9%) (2). Pulmonary hypertension and lung hypoplasia play a crucial role in determining survival in CDH (5). Neonates with prolonged ECMO run for >21 days have demonstrated higher mortality due to the increased risk of mechanical complications (6).Veno-arterial (V-A) ECMO still represents the support of choice in neonates, with more than 80% receiving V-A support (2). The vessel size is the most critical limiting factor in using the veno-venous (V-V) ECMO in neonates as the smallest double-lumen venous cannula currently commercially available is 13 Fr (3, 7). However, it should be noted that mortality is not significantly different between the two types of support. However, neurological complications are reported to be

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Neonatal respiratory extracorporeal membrane oxygenation and primary diagnosis: trends between two decades

Cited by 10 publications

References 41 publications

Neonatal respiratory and cardiac ECMO in Europe

Neonatal respiratory and cardiac ECMO in Europe

Neonatal ECMO in Severe Bronchiolitis: Our Experience in the Last 10 Years.

Editorial: Neonatal ECMO in 2019: Where Are We Now? Where Next?

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