ORIGINAL ARTICLE

Predicting outcome in ex-premature infants supported with extracorporeal membrane oxygenation for acute hypoxic respiratory failure

K L Brown¹, G Walker³, D J Grant⁴, K Tanner⁵, D A Ridout², L S Shekerdemian¹, J H Smith⁵, C Davis³, R K Firmin⁴, A P Goldman¹

¹ Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
² Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London
³ Department of Paediatric Surgery, Royal Hospital for Sick Children, Glasgow, Scotland, UK
⁴ Paediatric Intensive Care Unit, Glenfield Hospital, Leicester, UK
⁵ Paediatric Intensive Care Unit, Freeman Hospital, Newcastle Upon Tyne, UK

Correspondence to:
Correspondence to:
Dr Goldman
Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK; Goldma1{at}gosh.nhs.uk

Objective: To identify predictors of outcome in ex-premature infants supported with extracorporeal membrane oxygenation (ECMO) for acute hypoxic respiratory failure.

Methods: Retrospective review of ex-premature infants with acquired acute hypoxic respiratory failure requiring ECMO support in the United Kingdom from 1992 to 2001. Review of follow up questionnaires completed by general practitioners and local paediatricians.

Results: Sixty four ex-premature infants (5–10 each year) received ECMO support, despite increased use of advanced conventional treatments over the decade. The most common infective agent was respiratory syncytial virus (85% of cases). Median birth gestation was 29 weeks and median corrected age at the time of ECMO support was 42 weeks. Median ECMO support duration was relatively long, at 229 hours. Survival to hospital discharge and to 6 months was 80%, remaining similar throughout the period of review. At follow up, 60% had long term neurodisability and 79% had chronic pulmonary problems. Of pre-ECMO factors, baseline oxygen dependence, younger age, and inpatient status were associated with non-survival (p  0.05). Of ECMO related factors, patient complications were independently associated with adverse neurodevelopmental outcome and death (p < 0.01).

Conclusions: Survival rates for ex-premature infants after ECMO support are favourable, but patients suffer a high burden of morbidity during intensive care and over the long term. At the time of ECMO referral, baseline oxygen dependence is the most important predictor of death, but no combination of the factors considered was associated with a mortality that would preclude ECMO support.

Abbreviations: AHRF, acute hypoxic respiratory failure; ECMO, extracorporeal membrane oxygenation; NICU, neonatal intensive care unit; RSV, respiratory syncytial virus

Keywords: extracorporeal membrane oxygenation; premature infant; respiratory syncytial virus; bronchiolitis

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