Neonatal extracorporeal membrane oxygenation: practice patterns and predictors of outcome in the UK

Ann Karimova ^1*, Kate Brown ¹, Deborah Ridout ², Wolfram Beierlein ¹, Jane Cassidy ³, Jon Smith ³, Hitesh Pandya ⁴, Richard Firmin ⁴, Morag Liddell ⁵, Carl Davies ⁵ and Allan Goldman ¹

¹ Cardiac Critical Care and ECMO unit, Great Ormond Street Hospital for Children, London, WC1N 3JH, United Kingdom
² Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, WC1N 1EH, United Kingdom
³ Dept. of PICU and ECMO, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, United Kingdom
⁴ Dept. of ECMO, Glenfield Hospital, Leicester, LE3 9QP, United Kingdom
⁵ Dept. of Paediatric Surgery and ECMO, Royal Hospital for Sick Children,Yorkhill, Glasgow G3 8SJ, United Kingdom

^* To whom correspondence should be addressed. E-mail: karima{at}gosh.nhs.uk.

Accepted 9 August 2008

Abstract

Objective: To review the UK neonatal ECMO service and identify predictors of outcome.

Design: Retrospective review of the national cohort.

Patients and Interventions: 718 neonates received ECMO for respiratory failure between 1993 and 2005.

Measurements and Results: Diagnoses were: 48.0% Meconium Aspiration Syndrome (97.1% survivors), 15.9% Congenital Diaphragmatic Hernia (CDH: 57.9% survivors), 15.9% Sepsis (62.3% survivors), 9.5% Persistent Pulmonary Hypertension (79.4% survivors), 5.6% Respiratory Distress Syndrome (92.5% survivors) and 5.1% Congenital lung abnormalities (24.3% survivors). The overall survival rate of 79.7% compared favourably with the Worldwide ELSO Registry. Over the period of review, pre-ECMO use of advanced respiratory therapies increased (P<0.001), but ECMO initiation was not delayed (P=0.61). The use of veno-venous (VV) ECMO increased (P<0.001) and average run time fell (P=0.004). Patients treated with VV ECMO had better survival (87.7%), compared to veno-arterial (VA) ECMO (73.4%) and only 42.4% of those needing conversion from VV to VA ECMO survived. In non-CDH neonates, lower birth weight, lower gestational age, older age at ECMO and higher OI were associated with increased risk of death. In CDH neonates, lower birth weight and younger age at ECMO were identified as risk factors for death.

Conclusion: The UK neonatal ECMO service achieves good outcomes and with overall survival rate reaching 80% compares favourable with international results. Advanced respiratory therapies are used widely in UK ECMO patients. Identification of higher OI and older age at ECMO as risk factors in non-CDH neonates reinforces the importance of timely referral for ECMO.