Extracorporeal membrane oxygenation (ECMO) for non-ECMO intensive care nurseries.
An extracorporeal membrane oxygenation (ECMO) centre has been established in the sole outborn-only level 3 nursery in Melbourne. In the absence of other guidelines, an infant may qualify for ECMO if the expected mortality, based on assessment of the severity of hypoxia, exceeds 80%. However, for a non-ECMO centre, this involves the additional hazard of transport for an already critically-ill infant. The aim of this study was to determine the predictors of at least 80% mortality in babies who might have qualified for ECMO but who were cared for in a non-ECMO level 3 nursery. Regardless of the severity or duration of hypoxia, we were unable to identify a group of infants whose mortality exceeded 80%. Since outborn infants were disproportionately over-represented amongst those who might qualify for ECMO, it would be advisable to admit preferentially those born outside the level 3 perinatal centres who might qualify for ECMO directly to the ECMO centre. For infants born within our level 3 perinatal centre, it is recommended not to transfer those who might qualify based on data from other centres until the exact role of ECMO is determined. Alternatively, a randomized controlled trial of transfer versus non-transfer to the ECMO centre for severely hypoxic infants cared for in non-ECMO level 3 nurseries could be considered.
Thambapillai
E
E
Division of Paediatrics, Royal Women's Hospital, Carlton, Victoria, Australia.
Doyle
L W
LW
Murton
L J
LJ
D001315:Australia; D015199:Extracorporeal Membrane Oxygenation; D005311:Fetal Hypoxia / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D011336:Probability; D014187:Transportation of Patients