How low can you go? Effectiveness and safety of extracorporeal membrane oxygenation in low-birth-weight neonates.
OBJECTIVE
Controversy exists regarding the criteria for placement of infants on extracorporeal membrane oxygenation (ECMO) at low birth weights. The authors hypothesized that ECMO is effective and safe in babies under 2 kg and sought to examine outcome and survival rate in these infants.


METHODS
All patients less than 30 days old in the Extracorporeal Life Support Organization (ELSO) registry (n = 14,305) were divided into those less than 2 kg (n = 663) and more than 2 kg (n = 13,642). Multiple regression analysis determined factors that predicted survival rate and the lowest safe weight for ECMO.


RESULTS
Overall survival rate was 76% and was lower in infants less than 2 kg (> or =2 kg, 77% v <2 kg, 53%, P <.0001). Survival rate was significantly lower for patients with diaphragmatic hernia (CDH), bleeding, and intracranial hemorrhage (ICH) by regression. The incidence of ICH in babies less than 2.0 kg was 6% versus 4% in those more than 2.0 kg (P <.05). Regression analysis determined that the lowest weight at which a survival rate of 40% could be achieved was 1.6 kg.


CONCLUSIONS
Cannulation for ECMO may be safe and effective in babies under 2.0 kg and potentially as low as 1.6 kg. Judicious anticoagulation might limit bleeding, which occurred in a minority of these patients.
Rozmiarek
Andrew J
AJ
Division of Pediatric Surgery, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Qureshi
Faisal G
FG
Cassidy
Laura
L
Ford
Henri R
HR
Gaines
Barbara A
BA
Rycus
Peter
P
Hackam
David J
DJ
D001034:Apgar Score; D001724:Birth Weight; D002245:Carbon Dioxide / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000401:mortality; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D008297:Male; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome
D002245:Carbon Dioxide