Benefits Of Extracorporeal Membrane Oxygenation Research Articles

Utility of venoarterial extracorporeal membrane oxygenation in patients with acute myocardial infarction complicated by cardiogenic shock

Abstract Background Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) continues to portend poor clinical prognosis and remains a major cause of morbidity and mortality. Although venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is frequently used in the treatment of AMI-CS, studies evaluating its benefit compared to percutaneous ventricular assist devices (pVAD) or standard medical therapy in this patient population have yielded conflicting results. Purpose The goal of this meta-analysis is to evaluate the use of ECMO compared to either pVAD or medical therapy with or without intra-aortic balloon counterpulsation (IABP) in patients presenting with AMI-CS. Methods A database search was performed for studies reporting on the association of ECMO compared to pVAD or medical therapy with or without IABP with clinical outcomes in patients with AMI-CS. The endpoints of interest were 30-day all-cause mortality and long term all-cause mortality. The databases searched included Pubmed, Web of Science, and Embase. The search was not restricted by time or publication status. Registry studies were excluded from this analysis. Results A total of 8 studies with 937 participants (447 treated with ECMO, 243 treated with pVAD, 247 treated with medical therapy with or without IABP) met inclusion criteria. Mean age was 63 years old, 80.5% were men, mean left ventricular ejection fraction was 26%, mean follow-up was 6.3 months (ranging 1-12 months). Treatment of AMI-CS patients with ECMO was not associated with lower risk of 30-day all-cause mortality compared to pVAD or standard medical therapy with or without IABP placement (OR 1.29, 95% CI 0.87-1.90; p=0.21; OR 0.58, 95% CI 0.25-1.35; p=0.13). Heterogenetic was low to moderate for each subgroup. Test for subgroup differences did not demonstrate statistically significant differences in the results for pVAD and for standard medical therapy with or without IABP (p=0.10, I2=64.1%). Compared to pVAD, ECMO was not associated lower risk of long-term mortality (OR 1.27, 95% CI 0.85-1.90; p=0.24). The heterogeneity for this analysis was low (I2=0%). Conclusion In patients presenting with AMI-CS, use of VA-ECMO is not associated with lower risk of mortality compared to pVAD or standard medical therapy with or without IABP placement. The risks and benefits of ECMO should be carefully considered compared to other forms of temporary mechanical circulatory support.Figure 1

Extracorporeal Membrane Oxygenation in Acute Aluminum Phosphide (AlP) Poisoning

Introduction: Aluminum Phosphide (AlP) poisoning is a life-threatening condition that commonly occurs in developing countries, often resulting in cardiac, respiratory, and metabolic complications, leading to multi-organ failure and mortality. Extracorporeal Membrane Oxygenation (ECMO) has been proposed as a potential therapy for severe AlP poisoning cases refractory to conventional management, though its use remains controversial. Methodology: for this literature review, we conducted a comprehensive analysis of existing literature concerning the utilization of ECMO in patients with severe AlP poisoning. We meticulously examined available publications to explore the relationship between ECMO initiation and patient outcomes. Discussion: The review reveals that early ECMO initiation within 6 hours of presentation is associated with better outcomes and higher survival rates in severe AlP poisoning cases. However, uncertainties persist regarding the optimal timing and duration of ECMO support, and potential complications, including bleeding, acute renal injury, and ventilator-associated pneumonia, need careful consideration. Conclusion: Despite promising results in certain cases, the risks and benefits of ECMO in AlP poisoning require meticulous evaluation. Ethical considerations, encompassing resource allocation and implications for other patients, necessitate appropriate patient selection criteria.

Successful extracorporeal membrane oxygenation for postoperative cardiopulmonary failure in newborns with congenital diaphragmatic hernia: case reports and literature reviews.

Congenital diaphragmatic hernia (CDH) is a structural defect caused by inadequate fusion of the pleuroperitoneal membrane that forms the diaphragm, allowing peritoneal viscera to protrude into the pleural cavity. Up to 30% of newborns with CDH require extracorporeal membrane oxygenation (ECMO) support. As with all interventions, the risks and benefits of ECMO must be carefully considered in these patients. Cardiopulmonary function has been shown to worsen rather than improve after surgical CDH repair. Even after a detailed perioperative assessment, sudden cardiopulmonary failure after surgery is dangerous and requires timely and effective treatments. Three cases of cardiopulmonary failure after surgical CDH treatment in newborns have been reported. ECMO support was needed for these three patients and was successfully discontinued. We report our treatment experience. ECMO is feasible for the treatment of postoperative cardiopulmonary failure in newborns with CDH.

Improving the Numbers, But Harming the Patient? The Authors Respond.

To the Editor: We thank da Costa et al.1 for their letter which makes some interesting observations. We agree that our study alone cannot be used to justify the use of extracorporeal membrane oxygenation (ECMO) as a strategy to protect the lungs in patients with moderate acute respiratory failure (ARF)—nor do we make a claim that it should. Severity of respiratory failure is not just defined by a single PaO2/FiO2 ratio value, but on a more complex clinical evaluation which must also take into account the duration of hypoxemia. We take this opportunity to stress that all patients in our study2 had ARF severe enough to receive ECMO based on the indications established by our national service. The “less severe” group had a median PaO2/FiO2 ratio of 105 mm Hg despite median FiO2 of 0.85, but fulfilled other criteria for ECMO. As this cohort was matched for PaCO2 with the “very severe” group, it is likely the price the patient has to pay for the PaO2/FiO2 ratio is injurious mechanical ventilation. Therefore, we would suggest that many of these patients would already meet criteria for ECMO in many systems, and that we are not advancing a “new” indication. There is now substantial evidence for the association between increased mechanical power, ventilator-induced lung injury and mortality in ARF,3 and in this context the use of ECMO allows the least damaging lung ventilation strategy4 and better outcomes.5 We would suggest, intuitively, that increased duration of high mechanical power to the lungs will thus increase mortality even if PaO2/FiO2 ratio is not yet “severe.” High mechanical power can—in the short term—increase PaO2/FiO2 masking the severity of disease, but ultimately increasing mortality. This was exactly what happened in the OSCILLATE Trial, where high-flow oscillatory ventilation resulted in better oxygenation but worse patient outcomes.6 The results of more recent studies are consistent with our findings: a large multinational cohort study of coronavirus patients suggested a survival benefit in those with PaO2/FiO2 ratio of 120–150 mm Hg.7 Da Costa et al. are correct also to identify the subset of ARF patients who experience acute right ventricular dysfunction, which is often exacerbated by “lung-protective” ventilation measures.8 Whether, or at what stage, such patients may benefit from ECMO support, is not a question our study can answer. The task then is how best to determine the answer to these questions? Do patients with “moderate-severe” respiratory failure benefit from ECMO? What about those with acute right ventricle (RV) dysfunction? Ultimately, we agree with da Costa et al. that in the absence of randomized controlled trials, the solution is in high-quality observational registries of ARF, not just of therapies such as ECMO, with advanced causal inference methods. For the individual patient, we suggest that the optimal strategy remains to identify the point at which the benefits of ECMO in preventing hypoxia and avoiding injurious lung ventilation outweigh its risks.

Combined Use of Subnormothermic Extracorporeal Support and Hypothermic Oxygenated Machine Perfusion for Liver Graft After Cardiac Death in Pigs

The use of grafts from donors after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. This study aims to determine the benefits of extracorporeal membrane oxygenation (ECMO) and hypothermic oxygenated machine perfusion (HOPE) in a large animal model of DCD liver. After cardiac arrest, the abdominal aorta and the inferior vena cava were cannulated and connected to an ECMO circuit. Porcine livers were perfused in situ with ECMO at 22°C for 60 minutes after 45 minutes of cardiac death. Then, the livers were perfused for 4 hours by cold storage (CS) or HOPE. In group 1, non-in situ ECMO and grafts were preserved by HOPE. In group 2, in situ ECMO and grafts were preserved by HOPE. In group 3, in situ ECMO and grafts were preserved by CS. After preservation, all grafts were evaluated using an isolated reperfusion model (IRM) with autologous blood for 2 hours. During HOPE, aspartate aminotransferase (AST) levels and hepatic arterial pressure in group 2 tended to be lower than in group 1. Hematoxylin-eosin staining findings after HOPE showed more massive sinusoidal congestion and hepatocyte cytoplasmic vacuolization in group 1 than in group 2. The AST and LDH levels in group 2 at the start-up of IRM tended to be lower than in group 1. The combined use of in situ subnormothermic ECMO and HOPE is essential for the functional recovery of DCD liver grafts.

Acute Respiratory Distress Syndrome due to Influenza A Treated with Extracorporeal Membrane Oxygenation: A Case Report and Review of the Literature

Influenza is a viral respiratory infection that can lead to significant morbidity and mortality. Due to its high susceptibility to antigenic variation, influenza A is responsible for causing pandemics. Fever, cough, dyspnea, and vomiting are common presenting symptoms. The spectrum of an influenza A virus infection ranges from a mild upper respiratory illness to life-threatening pneumonia. Hypoxia and chest radiographs consistent with acute respiratory distress syndrome (ARDS) are seen in patients requiring intensive care. The reported incidence of patients with influenza A-associated ARDS requiring transition from conventional ventilation to extracorporeal membrane oxygenation (ECMO) is variable. ECMO can be considered in patients with reversible respiratory failure, who are already on maximal conventional therapy and are not achieving lung-protective ventilation; wherein the benefits of ECMO are deemed to outweigh its risks. We describe the case of a 48-year-old female who developed ARDS secondary to influenza A requiring mechanical ventilation and extracorporeal membrane oxygenation (ECMO).

The role of extracorporeal membrane oxygenation in adult liver transplant patients: A qualitative systematic review of literature.

A paucity of evidence exists regarding risks and benefits of extracorporeal membrane oxygenation (ECMO) in adult liver transplantation. This was a systematic review conducted from January 1, 2000 to April 24, 2020 of adult liver transplant recipients (pre- or post-transplant) and donors who underwent Veno-arterial or Veno-venous ECMO cannulation. Death was the primary outcome, with graft function and complications as secondary outcomes. Forty-one articles were identified that fit criteria. A total of 183 donors were placed on ECMO, with recipient complication profiles and mortality that mirrored rates from standard criteria donors. Sixty-one recipients were placed on ECMO intraoperatively or postoperatively. Most patients experienced at least one complication with infections as the most common cause and minimal complications specifically related to ECMO use. Multisystem organ failure (MSOF) and infections were more common among liver recipients who died compared to those who survived. Overall mortality at 90days was 45.9%. Causes of death were most commonly MSOF and infections. ECMO use in adult liver transplantation is a useful adjunct. Recipient morbidity and mortality from donors placed on ECMO parallel that of recipients from standard criteria donors, and morbidity and mortality of recipients placed on ECMO are similar to other ECMO populations.

Clinical Characteristics and Outcomes of Children With Extracorporeal Membrane Oxygenation in a Developing Country: An 11-Year Single-Center Experience.

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving procedure for patients with refractory cardiac or respiratory failure. The indications for ECMO are growing, and it is increasingly being used to support cardiopulmonary failure in children. However, the risks and benefits of ECMO should be weighed before deploying it on the patients. The objectives of this study were to identify the mortality risk factors and to determine the ECMO outcomes.Methods: The retrospective chart reviews were done for all patients aged 1 day−20 years old receiving ECMO between January 2010 and December 2020.Results: Seventy patients were enrolled in the study. The median age was 31.3 months. The incidence of VA and VV ECMO was 85.7 and 14.3%, respectively. The most common indication for ECMO was the failure to wean off cardiopulmonary bypass after cardiac surgery. Pre-existing acute kidney injury (OR 4.23; 95% CI 1.34–13.32, p = 0.014) and delayed enteral feeding (OR 3.85, 95% CI 1.23–12.02, p = 0.020), and coagulopathy (OD 12.64; 95% CI 1.13–141.13, p = 0.039) were associated with the higher rate of mortality. The rates of ECMO survival and survival to discharge were 70 and 50%, respectively.Conclusion: ECMO is the lifesaving tool for critically ill pediatric patients. Pre-existing acute kidney injury, delayed enteral feeding, and coagulopathy were the potential risk factors associated with poor outcomes in children receiving ECMO. However, ECMO setup can be done successfully in a developing country.

Role of extracorporeal membrane oxygenation in children with sepsis: a systematic review and meta-analysis

BackgroundThe benefits of extracorporeal membrane oxygenation (ECMO) in children with sepsis remain controversial. Current guidelines on management of septic shock in children recommend consideration of ECMO as salvage therapy. We sought to review peer-reviewed publications on effectiveness of ECMO in children with sepsis.MethodsStudies reporting on mortality in children with sepsis supported with ECMO, published in PubMed, Scopus and Embase from 1972 till February 2020, were included in the review. This study was done in adherence to Preferred Reporting Items for Systematic Review and Meta-Analysis statement after registering the review protocol with PROSPERO. Study eligibility was independently assessed by two authors and disagreements resolved by a third author. Publications were reviewed for quality using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Random-effects meta-analyses (DerSimonian and Laird) were conducted, and 95% confidence intervals were computed using the Clopper-Pearson method. Outliers were identified by the Baujat plot and leave-one-out analysis if there was considerable heterogeneity. The primary outcome measure was survival to discharge. Secondary outcome measures included hospital length of stay, subgroup analysis of neonatal and paediatric groups, types and duration of ECMO and complications.ResultsOf the 2054 articles screened, we identified 23 original articles for systematic review and meta-analysis. Cumulative estimate of survival (13 studies, 2559 patients) in the cohort was 59% (95%CI: 51–67%). Patients had a median length of hospital stay of 28.8 days, median intensive care unit stay of 13.5 days, and median ECMO duration of 129 h. Children needing venoarterial ECMO (9 studies, 208 patients) showed overall pooled survival of 65% (95%CI: 50–80%). Neonates (< 4 weeks of age) with sepsis needing ECMO (7 studies, 85 neonates) had pooled survival of 73% (95%CI: 56- 87%). Gram positive organisms were the most common pathogens (47%) in septic children supported with ECMO.ConclusionSurvival rates of children with sepsis needing ECMO was 59%. Neonates had higher survival rates (73%); gram positive organisms accounted for most common infections in children needing ECMO. Despite limitations, pooled survival data from this review indicates consideration of ECMO in refractory septic shock for all pediatric age groups.

Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia.

Congenital diaphragmatic hernia (CDH) is characterized by failure of diaphragmatic development with lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). If conventional treatment with gentle ventilation and optimized vasoactive medication fails, extracorporeal membrane oxygenation (ECMO) may be considered. The benefits of ECMO in CDH are still controversial, since there are only few randomized trials demonstrating the advantages of this therapeutic option. At present, there is no precise prenatal and/or early postnatal prognostication parameter to predict reversibility of PPHN in CDH patients. Indications for initiating ECMO include either respiratory or circulatory parameters, which are also undergoing continuous refinement. Centers with higher case numbers and the availability of ECMO published promising survival rates, but data on long-term results, including morbidity and quality of life, are rare. Survival might be influenced by the timing of ECMO initiation and the timing of surgical repair. In this regard a trend toward early initiation of ECMO and early surgery on ECMO exists. The results concerning the cannulation modes are similar and a consensus on time limit for ECMO runs does not exist. The use of ECMO in CDH will continue to be evaluated, and prospective randomized trials and registry network are necessary to help answering the addressed questions of patient selection and management.

Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure.

Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

Applicability of Combined Use of Extracorporeal Support and Temperature-Controlled Machine Perfusion Preservation for Liver Procurement of Donors After Cardiac Death in Pigs

BackgroundThe use of grafts from donors after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. The objective of this study is to determine the benefits of extracorporeal membrane oxygenation (ECMO) and subnormothermic machine perfusion (MP) with rewarming in a large animal model of DCD liver. MethodsAfter cardiac arrest, the abdominal aorta and the inferior vena cava were cannulated and connected to an ECMO circuit. Porcine livers were perfused in situ with ECMO at 22°C for 60 minutes after 60 minutes of cardiac death. Then the livers were perfused for 4 hours by MP as a graft viability test. In group 1, non–in situ ECMO and grafts were preserved hypothermic MP. In group 2, non–in situ ECMO and grafts were preserved subnormothermic rewarming MP. In group 3, we used ECMO and subnormothermic rewarming MP. To assess potential methods and effect, effluent enzymes were measured. Portal vein and hepatic artery pressure during MP were evaluated. ResultsEffluent enzyme of AST, alanine aminotransferase and LDH as viability markers were significantly low (aspartate aminotransferase, 2899, 2292, and 972 IU/L; alanine aminotransferase, 134, 140, and 72 IU/L; and lactate dehydrogenase, 4354, 4455, and 1855 IU/L in each group, respectively). Portal vein and hepatic artery pressure during preservation came down smoothly in group 3 compared with group 1. ConclusionsThe combined use of in situ subnormothermic ECMO and machine preservation with rewarming is more essential for the recovery and resuscitating function of DCD liver grafts.

Extracorporeal membrane oxygenation use has increased by 433% in adults in the United States from 2006 to 2011.

Recent studies have shown the benefits of extracorporeal membrane oxygenation (ECMO) in supporting adults with severe respiratory or cardiac failure refractory to conventional treatments. The purpose of this investigation was to analyze the usage of ECMO in adults to identify recent trends within the United States. The usage of ECMO, the survival rates, and the hospitalization costs from 2006 to 2011 were analyzed using the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project. The rate of ECMO cases per million adult discharges increased 433% from 11.4 (95% confidence interval, 6.1-16.8) in 2006 to 60.9 (95% confidence interval, 28.1-93.7) in 2011 (p for trend = 0.001). There was a trend toward improved survival rates, but this was not statistically significant (p for trend = 0.14). The costs per day have not changed significantly (p for trend = 0.07) nor have the total costs per patient (p for trend = 0.87). In conclusion, there was a huge increase in the usage of ECMO in adults from 2006 to 2011 with a trend toward improved survival rates and no increase in hospitalization costs.

Identification of the Nodose Ganglia and TRPV1 in Swine

The vagal nerve is the tenth cranial nerve (CN) and is the only CN to extend through the neck into the thorax and abdomen. As a component of the autonomic nervous system, the vagal nerve innervates the visceral organs, including the lung. The majority of the bronchopulmonary sensory nerves are unmyelinated (C-fiber) afferents of the vagal nerve. The cell bodies of the visceral afferent fibers of the vagus nerve are located bilaterally in the inferior ganglion—also termed the nodose ganglia (NG). More recently, transient receptor potential vanilloid type 1 (TRPV1) channels have been identified and are expressed on the vagal C-fiber afferents, which play an important role in the cholinergic reflex pathway [1–3]. TRPV1 channels are nonselective cation channels and polymodal transducers that are known to be activated by increasing temperature, acidity (hydrogen ion), and endogenous inflammatory mediators [1– 3]. Although differences exist between swine and human anatomy, the patterns of the vagal nerve are largely similar and closer in size than standard rodent models [4]. Data are limited on identifying autonomic neurons and associated cell bodies, including the NG in swine [5, 6]. The importance and study of pulmonary neurobiology in acute lung injury is gaining momentum and often requires the use of large animal models, including swine. With no previous reports of the identification and subsequent histopathologic confirmation of the NG and TRPV1 in swine, we provide our experiences in identifying the NG in common crossbred piglets used in an acute lung injury model investigating the benefits of extracorporeal membrane oxygenation. The vagal nerve was dissected based on anticipated location. Figure 1 outlines the two anatomical patterns of the vagal laryngeal branches as previously described by Ding et al. [4]. Figure 2 illustrates the NG structure of one animal on gross examination with this animal having anatomical pattern A from Fig. 1. Histopathologic assessment confirmed the NG on hematoxylin The study was approved by the Institutional Animal Care and Use Committee (IACUC) of the Nationwide Children’s Hospital with strict adherence to the IACUC guidelines regarding humane use of animals.

Benefits of extracorporeal membrane oxygenation for major blunt tracheobronchial trauma in the paediatric age group

Tracheobronchial rupture due to blunt chest trauma is a rare but life-threatening injury among children. The severity of this condition ranges from death before hospital admission to clinical stability resulting in delayed management. Diagnosis is difficult because there is sometimes no evidence of external trauma, in spite of severe chest crush injury and consecutive rupture of airways. Here, we report the case of a 32-month-old girl whose torso was crushed by a van, resulting in bilateral bronchi disconnection. She was admitted to our hospital with cardiac and respiratory arrest. After prompt resuscitation, flexible bronchoscopy permitted the accurate visualization of the rupture and its extent. The life-saving procedure consisted of surgical repair using extracorporeal membrane oxygenation (ECMO) as ventilatory support. This provided rapid relief from the injury, which was previously expected to result in death. These data suggest that ECMO could be beneficial as supportive therapy for selected paediatric patients with major tracheobronchial traumas.

Cochrane review: Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants

AbstractBackgroundNeonatal extracorporeal membrane oxygenation (ECMO) is a complex procedure of life support used in severe but potentially reversible respiratory failure in term infants. Although the number of babies eligible for ECMO is small and the use of ECMO invasive and potentially expensive, its benefits may be high.ObjectivesTo determine whether ECMO used for neonatal infants with severe respiratory failure is clinically and cost effective compared to conventional ventilatory support.Search strategyThe Cochrane Neonatal Group Specialised Register, the Cochrane Controlled Trials Register, and MEDLINE were searched for 1974 to 2007.Selection criteriaAll randomised trials comparing neonatal ECMO to conventional ventilatory support.Data collection and analysisThe authors independently evaluated the trials for methodological quality and appropriateness for inclusion in the Review (without consideration of their results) and independently extracted the data.Main resultsThe four trials (three USA and one UK) recruited clinically similar groups of babies. Two trials excluded infants with congenital diaphragmatic hernias. In two trials, transfer for ECMO implied transport over long distances. Two trials had follow‐up information. One study included economic evaluation.The three USA trials had very small numbers of patients. Two trials used conventional randomisation with low potential for bias. Two used less usual designs, which led to difficulties in their interpretation.All four trials showed strong benefit of ECMO on mortality (typical RR 0.44; 95% CI 0.31 to 0.61), especially for babies without congenital diaphragmatic hernia (typical RR 0.33, 95% CI 0.21 to 0.53).The UK trial provided follow up information about death or severe disability, and cost‐effectiveness, and showed benefit of ECMO at one year (RR 0.56, 95% CI 0.40 to 0.78), four years (RR 0.62, 95% CI 0.45 to 0.86), and seven years (RR 0.64, 95% CI 0.47 to 0.86). Overall nearly half of the children recruited had died or were severely disabled by seven years of age, reflecting the severity of their underlying conditions. A policy of ECMO is as cost‐effective as other intensive care technologies in common use.Authors' conclusionsA policy of using ECMO in mature infants with severe but potentially reversible respiratory failure results in significantly improved survival without increased risk of severe disability. The benefit of ECMO for babies with diaphragmatic hernia is unclear.Further studies are needed to consider the optimal timing for introducing ECMO; to identify which infants are most likely to benefit; and to address the implications of neonatal ECMO during later childhood and adult life.Plain Language SummaryExtracorporeal membrane oxygenation for severe respiratory failure in newborn infantsA complex life support procedure, called extracorporeal membrane oxygenation (ECMO), can be used in infants who are near term age to overcome severe, potentially reversible breathing problems. ECMO is similar to the technology used in cardiac bypass surgery. Blood is removed from the body of the patient, oxygen is added to the blood, and the blood is returned to the patient. Although the number of babies requiring ECMO is small, and ECMO is a very invasive and potentially expensive procedure, the benefits of this procedure are high. In this review, four randomized trials that compared the use of ECMO to the conventional approach to supporting these infants with severe breathing problems were identified. Overall, these trials showed a strong benefit for ECMO regarding survival at the time of hospital discharge. This is particularly true for infants without a specific problem of lung formation (congenital diaphragmatic hernia). The result implies that for every three babies with breathing problems and lung failure who were treated with ECMO rather than conventional ventilation, one more infant will survive. Although little information is available regarding long‐term follow‐up, one trial in the United Kingdom shows both benefits of ECMO and cost‐effectiveness of the use of ECMO.

Benefits of extracorporeal membrane oxygenation for hydrocarbon pneumonitis.

To review the therapeutic benefits of extracorporeal membrane oxygenation for the management of hydrocarbon pneumonitis. A search of the medical literature was conducted through Medline and the bibliographies of relevant articles and a search of patient databases maintained by the Extracorporeal Life Support Organization and the American Association of Poison Control Centers was performed. All articles and case reports on the use of extracorporeal membrane oxygenation in patients with hydrocarbon pneumonitis were selected. The data were abstracted without judgments about study design. There is some evidence that pulmonary parenchymal tissue can recover from hydrocarbon pneumonitis, but the degree of injury and recovery are variable. In the Extracorporeal Life Support Organization Registry 19 children with hydrocarbon pneumonitis were treated with extracorporeal membrane oxygenation during 1985 to 1994 and 68% survived compared to the 52% overall survival of 883 pediatric cases who had a diagnosis of a respiratory condition. A review of the American Association of Poison Control Centers data for 1993 and 1994 identified five cases of hydrocarbon pneumonitis in which extracorporeal membrane oxygenation was used and two survived. There are two full case descriptions in the literature with both children surviving, but one child developed persistent moderate left hemiparesis and seizure activity. The need for extracorporeal membrane oxygenation is rare owing to the generally good outcome of most cases of hydrocarbon ingestions and pneumonitis. Only with further research on the nature and clinical course of severe hydrocarbon pneumonitis, refinement of extracorporeal membrane oxygenation criteria, and evaluation of alternative therapies, will the benefits of extracorporeal membrane oxygenation be better defined.