title: Prolonged extracorporeal membrane oxygenator support among neonates with acute respiratory failure: a review of the Extracorporeal Life Support Organization registry.
abstract: The objective of this study was to identify types of neonatal diseases associated with prolonged (≥21 days) extracorporeal membrane oxygenation (ECMO), characteristics of survivors and nonsurvivors among those requiring prolonged ECMO, and factors associated with mortality. Data were obtained from the Extracorporeal Life Support Organization registry over the period from January 1, 1998, through December 31, 2011, for all neonates (age <31 days), with respiratory failure as the indication for ECMO. The primary outcome was survival to hospital discharge. Survivors and nonsurvivors were compared for 1) patient demographics, 2) primary diagnosis, 3) pre-ECMO clinical course and therapies, and 4) ECMO course and associated complications. The most common diagnosis associated with prolonged ECMO support in neonates is congenital diaphragmatic hernia (CDH; 69%). Infants with meconium aspiration syndrome had the highest survival rate (71%) compared with other diagnoses analyzed (26.3%; p < 0.001). Nonsurvivors were more likely to experience complications on ECMO, and multivariate analysis showed that the need for inotropes while on ECMO support (odds ratio, 2.2 [95% confidence interval, 1.3-3.7]; p = 0.003) was independently associated with mortality. Neonates requiring prolonged ECMO support have a 24% survival to discharge. Many of these cases involve CDH. Complications are common with prolonged ECMO, but only receipt of inotropes was shown to be independently associated with mortality. This report may help guide clinical decision making and family counseling for neonates requiring prolonged ECMO support.
authors.affiliation: From the *Department of Pediatrics, Division of Cardiology, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; †Department of Pediatrics, Division of Critical Care, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; ‡Department of Pediatrics, Division of Neonatology, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; §Extracorporeal Life Support Organization, Ann Arbor, Michigan; ¶Department of Pediatrics, Division of Critical Care, Seattle Children's Hospital, Seattle, Washington; and ‖Division of Biostatistics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.forename: Michael
authors.initials: M
authors.lastname: Stroud
authors.forename: Nahed
authors.initials: N
authors.lastname: El-Hassan
authors.forename: Sarah
authors.initials: S
authors.lastname: Peeples
authors.forename: Peter
authors.initials: P
authors.lastname: Rycus
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Brogan
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012042:Registries; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies