Patient selection for neonatal extracorporeal membrane oxygenation: beyond severity of illness.
OBJECTIVE
To explore how neonates with respiratory failure are selected for extracorporeal membrane oxygenation (ECMO) once severity of illness criteria are met, and to determine how conflicts between ECMO providers and parents over the initiation of ECMO are addressed.


METHODS
A cross-sectional study was conducted using a data collection survey, which was sent to the directors of neonatal respiratory ECMO centers.


RESULTS
The lowest birth weight and gestational age at which respondents would consider placing a neonate on ECMO were frequently below recommended thresholds. There was wide variability in respondents' willingness to place neonates on ECMO in the presence of conditions such as intraventricular hemorrhage and hypoxic ischemic encephalopathy. The number of respondents who would never seek to override parental refusal of ECMO was equal to the number who would always do so.


CONCLUSIONS
Significant variability exists in the selection criteria for neonatal ECMO and in how conflicts with parents over the provision of ECMO are resolved.
Chapman
R L
RL
Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520-5426, USA.
Peterec
S M
SM
Bizzarro
M J
MJ
Mercurio
M R
MR
D001724:Birth Weight; D003625:Data Collection; D015199:Extracorporeal Membrane Oxygenation / Q000592:standards* / Q000706:statistics & numerical data; D005865:Gestational Age; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D018579:Patient Selection; D012131:Respiratory Insufficiency / Q000628:therapy*; D012720:Severity of Illness Index