Delayed institution of extracorporeal membrane oxygenation is associated with increased mortality rate and prolonged hospital stay☆,☆☆
Section snippets
Materials and methods
The national ECMO registry of the Extracorporeal Life Support Organization (ELSO, Ann Arbor, MI) contains voluntarily reported data on demographics, laboratory and diagnostic information, and clinical course for neonates treated with ECMO. This database was examined and a subset of data generated for those neonates treated with ECMO for MAS-induced respiratory failure and was restricted further to the 1989 through 1998 decade to include only those patients treated with the most current methods
Results
Overall mortality rate was 5.8%. A delay in the initiation of ECMO for more than 96 hours (group 3) was associated with a significant increase in mortality rate when compared with ECMO therapy instituted at less than 24 hours (4.8% v 7.7%, P <.05; Fig 1).
The increase in time to ECMO also was associated with a significant increase in the length of ECMO support in these same groups
Discussion
Our data show that delays in treating high-risk MAS infants with ECMO result in significantly longer time on mechanical ventilation. The increase in ventilator time is divided among increases in pre-ECMO ventilation, length of ECMO run, and duration of post-ECMO ventilator requirement. Trials of alternative therapies (HFOV and inhaled nitric oxide) also result in significantly longer ventilator requirements.
Recent data show that although fewer patients are being treated with ECMO overall, these
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Cited by (31)
Extracorporeal membrane oxygenation in patients with hepatopulmonary syndrome undergoing liver transplantation: A systematic review of the literature
2022, Transplantation ReviewsCitation Excerpt :In this group, we also identified time to ECMO initiation as being correlated with duration of ECMO support in patients cannulated post-operatively. This is consistent with prior studies of ECMO use in other contexts, where increased time-to-ECMO was associated with increased mortality and prolonged ECMO duration in infants with meconium aspiration syndrome [39], increased mortality in pediatric LT recipients [40], and increased mortality in adults with COVID-19, traumatic injuries, or post-cardiac surgery [41–43]. Despite the known risks associated with ECMO, earlier initiation in patients meeting criteria may abbreviate ECMO duration, decrease the risk of associated complications, and improve overall survival [44].
Respiratory Disorders in the Term Infant
2018, Avery's Diseases of the Newborn: Tenth EditionRespiratory Disorders in the Term Infant
2017, Avery's Diseases of the Newborn, Tenth EditionCombining ECMO with IABP for the Treatment of Critically Ill Adult Heart Failure Patients
2014, Heart Lung and CirculationCitation Excerpt :In this study, 13 patients (24%) were successfully weaned from mechanical support, but died from complications such as infection, liver and kidney failure as well as CNS complications. Taken together, this suggests that for post-operational patients with severe heart disease, once there is clear indication for the procedure, mechanical circulatory support should be established in a timely manner in order to prevent an increase in death rate due to delayed treatments [15,16]; complications related to mechanical circulatory support should be prevented as much as possible to further increase the survival rate. There is already evidence that in terms of working principle, ECMO and IABP are synergistic and complementary to each other [16].
Respiratory Failure in the Term Newborn
2012, Avery's Diseases of the Newborn (Ninth Edition)Respiratory failure in the term newborn
2011, Avery's Diseases of the Newborn
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The authors acknowledge the support of the ECMO registry of the Extracorporeal Life Support Organization (ELSO) of Ann Arbor, Michigan.
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Address reprint requests to Kevin P. Lally, Division of Pediatric Surgery, MSB 5.258, 6431 Fannin St, Houston, TX 77030.