Echocardiographic prediction of neonatal ECMO outcome.
Cardiopulmonary physiology was assessed by Doppler echocardiography in neonates undergoing pre-ECMO evaluation for meconium aspiration syndrome, congenital diaphragmatic hernia, persistent fetal circulation, and sepsis, from March 1987 through July 1992 (n = 136). Percent survival by diagnosis was: meconium aspiration syndrome, 86%; persistent fetal circulation, 68%; congenital diaphragmatic hernia, 63%; sepsis, 33%. Survival odds by diagnosis predicted a better outcome for meconium aspiration syndrome than for congenital diaphragmatic hernia and sepsis, and a better outcome for persistent fetal circulation than for sepsis. Percent survival for right-to-left patent ductus arteriosus flow (PDA) was 56%; other patent ductus arteriosus flow was 84%. In multivariate analysis, percent survival in congenital diaphragmatic hernia and persistent fetal circulation patients with right-to-left PDA flow suggested a worse outcome (% survival right-to-left vs other: congenital diaphragmatic hernia, 13% vs 70%; persistent fetal circulation, 25% vs 85%), whereas percent survival did not appear to suggest the same in meconium aspiration syndrome or sepsis patients. Similar analysis in non-ECMO patients suggested a worse outcome with right-to-left PDA flow in patients with meconium aspiration syndrome and congenital diaphragmatic hernia. Right-to-left PDA flow, sepsis, and congenital diaphragmatic hernia were associated with a poorer ECMO outcome. Initial assessment of PDA flow helps predict ECMO outcome.
Gotteiner
N L
NL
Department of Pediatrics, Division of Cardiology, The Children's Memorial Hospital, Chicago, IL 60614, USA.
Harper
W R
WR
Gidding
S S
SS
Berdusis
K
K
Wiley
A M
AM
Reynolds
M
M
Benson
D W
DW
D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging; D015150:Echocardiography, Doppler; D015199:Extracorporeal Membrane Oxygenation; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008471:Meconium Aspiration Syndrome / Q000000981:diagnostic imaging / Q000628:therapy; D010547:Persistent Fetal Circulation Syndrome / Q000000981:diagnostic imaging / Q000628:therapy; D011237:Predictive Value of Tests; D018805:Sepsis / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome