Extracorporeal membrane oxygenation with veno-venous bypass and apneic oxygenation for treatment of severe neonatal respiratory failure.
Seven newborn infants with life-threatening respiratory failure were treated with veno-venous (V-V) extracorporeal lung support and apneic oxygenation after maximal ventilatory and pharmacological treatment failed. Diagnosis were meconium aspiration syndrome in 3 cases, respiratory distress syndrome in 2, sepsis in 1, congenital diaphragmatic hernia in 1. Before ECMO 6 infants received tolazoline, 4 surfactant, 3 high frequency ventilation, 1 prostaglandin E, 1 epoprostenol, 2 nitric oxide. Newborns were highly hypoxemic at admission and all but one underwent rescue cannulation. V-V bypass was performed with a single lumen single cannula and tidal flow was generated by an alternating clamp using a non-occlusive roller pump. The mean duration of bypass was 162.4 +/- 162.3 hours and infants were extubated 94.5 +/- 74.8 hours after decannulation. Five newborns survived and two died. Growth and neurologic development of the older children is normal. The extracorporeal lung support with V-V bypass associated with apneic oxygenation was effective in reversing severe neonatal respiratory failure unresponsive to maximal ventilatory and pharmacological support. An early referral, prior to meeting ECMO criteria, is important in order to avoid hypoxic complications preceding ECMO.
Somaschini
M
M
Ospedali Riuniti, Bergamo, Italy.
Bellan
C
C
Locatelli
G
G
Glauber
M
M
Colombo
A
A
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D011464:Epoprostenol / Q000008:administration & dosage / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007231:Infant, Newborn; D009569:Nitric Oxide / Q000627:therapeutic use; D010101:Oxygen Consumption; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011458:Prostaglandins E / Q000008:administration & dosage / Q000627:therapeutic use; D011517:Prothrombin Time; D011663:Pulmonary Surfactants / Q000008:administration & dosage / Q000627:therapeutic use; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D014043:Tolazoline / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D000317:Adrenergic alpha-Antagonists; D010975:Platelet Aggregation Inhibitors; D011458:Prostaglandins E; D011663:Pulmonary Surfactants; D014665:Vasodilator Agents; D009569:Nitric Oxide; D014043:Tolazoline; D011464:Epoprostenol