Extracorporeal Membrane Oxygenation for Newborn Respiratory Failure

Abstract

Abstracts Respiratory failure is a common cause of death in newborn infants. The standard treatment for this condition (oxygen and airway pressure) can cause lung damage and is itself a major contributor to morbidity and death among the newborn. Abstracts Extracorporeal membrane oxygenation involves the use of a modified heart-lung machine to support gas exchange for a period of days or weeks until the lung has recovered. In the past 8 years, the present authors have used the method in the treatment of 45 newborn infants with respiratory failure. This report describes their total experience and updates previous publications on the subject. Abstracts The patients were selected and referred by neonatologists, who pronounced them unresponsive to maximum therapy. They were said to have less than a 10 per cent chance to survive before entering the study. Abstracts In all cases, venoarterial cardiopulmonary bypass was established by cannulating the right atrium via the right jugular vein and the aortic arch via the right common carotid artery. The extracorporeal circuit included polyvinylchloride tubing, a membrane lung, a pump with a 10-ml venous reservoir bladder, and a heat exchange to maintain temperature (Fig. 1). The priming volume of the circuit was approximately 450 ml. During priming, care was taken to ever, the patients were returned to maximal ventilatory support without extracorporeal membrane oxygenation. Four such patients suffered cardiac arrest, brain damage, or intracranial hemorrhage in the process. Abstracts Of 25 survivors, 20 are apparently normal, healthy children with normal growth and development. Two patients had mild spasticity of the lower extremities, which has since improved almost to the normal state. One child developed hydrocephalus in the newborn period and has a functioning ventriculoarterial shunt. One child has a large right encephalic cyst with severe neurological impairment at 2 years of age. Another child, treated for right-sided diaphragmatic hernia, regained sufficient pulmonary function to permit discontinuation of extracorporeal membrane oxygenation. This child was discharged briefly from the hospital but died of chronic respiratory failure at the age of 1 year and 6 months.