title: How low can you go? Effectiveness and safety of extracorporeal membrane oxygenation in low-birth-weight neonates.
abstract: 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.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Rozmiarek
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Qureshi
authors.forename: Laura
authors.initials: L
authors.lastname: Cassidy
authors.forename: Henri R
authors.initials: HR
authors.lastname: Ford
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Gaines
authors.forename: Peter
authors.initials: P
authors.lastname: Rycus
authors.forename: David J
authors.initials: DJ
authors.lastname: Hackam
mesh_terms: 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
chemical_list: D002245:Carbon Dioxide