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. 1986 Sep;204(3):236–245. doi: 10.1097/00000658-198609000-00003

Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure. 100 cases.

R H Bartlett, A B Gazzaniga, J Toomasian, A G Coran, D Roloff, R Rucker, A G Corwin
PMCID: PMC1251270  PMID: 3530151

Abstract

Extracorporeal membrane oxygenation (ECMO) was used in the treatment of 100 newborn infants with respiratory failure in three phases: Phase I (50 moribund patients to determine safety, efficacy, and risks); Phase II (30 high risk patients to compare ECMO to conventional ventilation); and Phase III (20 moderate to high risk patients, the current protocol). Seventy-two patients survived including 54% in Phase I, 90% in Phase II, and 90% in Phase III. The major complication was intracranial bleeding, which occurred in 89% of premature infants (less than 35 weeks) and 15% of full-term infants. Best survival results were in persistent fetal circulation (10, 10 survived), followed by congenital diaphragmatic hernia (9, 7 survived), meconium aspiration (44, 37 survived), respiratory distress syndrome (26, 13 survived), and sepsis (8, 3 survived). There were seven late deaths; in follow-up, 63% are normal or near normal, 17% had moderate to severe central nervous system dysfunction, and 8% had severe pulmonary dysfunction. ECMO is now used in several neonatal centers as the treatment of choice for full-term infants with respiratory failure that is unresponsive to conventional management. The success of this technique establishes prolonged extracorporeal circulation as a definitive means of treatment in reversible vital organ failure.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andrews A. F., Klein M. D., Toomasian J. M., Roloff D. W., Bartlett R. H. Venovenous extracorporeal membrane oxygenation in neonates with respiratory failure. J Pediatr Surg. 1983 Aug;18(4):339–346. doi: 10.1016/s0022-3468(83)80178-x. [DOI] [PubMed] [Google Scholar]
  2. Baden J. P., Sonnenfield M., Ferlic R. M., Sellers R. D. The BaSon test: a rapid bedside test for control of heparin therapy. Surg Forum. 1971;22:172–174. [PubMed] [Google Scholar]
  3. Bartlett R. H., Andrews A. F., Toomasian J. M., Haiduc N. J., Gazzaniga A. B. Extracorporeal membrane oxygenation for newborn respiratory failure: forty-five cases. Surgery. 1982 Aug;92(2):425–433. [PubMed] [Google Scholar]
  4. Bartlett R. H., Fong S. W., Burns N. E., Gazzaniga A. B. Prolonged partial venoarterial bypass: physiologic, biochemical, and hematologic responses. Ann Surg. 1974 Dec;180(6):850–856. doi: 10.1097/00000658-197412000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bartlett R. H., Gazzaniga A. B., Huxtable R. F., Schippers H. C., O'Connor M. J., Jefferies M. R. Extracorporeal circulation (ECMO) in neonatal respiratory failure. J Thorac Cardiovasc Surg. 1977 Dec;74(6):826–833. [PubMed] [Google Scholar]
  6. Bartlett R. H., Gazzaniga A. B., Jefferies M. R., Huxtable R. F., Haiduc N. J., Fong S. W. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs. 1976;22:80–93. [PubMed] [Google Scholar]
  7. Bartlett R. H., Gazzaniga A. B., Wetmore N. E., Rucker R., Huxtable R. F. Extracorporeal membrane oxygenation (ECMO) in the treatment of cardiac and respiratory failure in children. Trans Am Soc Artif Intern Organs. 1980;26:578–581. [PubMed] [Google Scholar]
  8. Bartlett R. H., Kittredge D., Noyes B. S., Jr, Willard R. H., 3rd, Drinker P. A. Development of a membrane oxygenator: overcoming blood diffusiolimitation. J Thorac Cardiovasc Surg. 1969 Dec;58(6):795–800. [PubMed] [Google Scholar]
  9. Bartlett R. H., Roloff D. W., Cornell R. G., Andrews A. F., Dillon P. W., Zwischenberger J. B. Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study. Pediatrics. 1985 Oct;76(4):479–487. [PubMed] [Google Scholar]
  10. Cohen R. S., Stevenson D. K., Malachowski N., Ariagno R. L., Johnson J. D., Sunshine P. Late morbidity among survivors of respiratory failure treated with tolazoline. J Pediatr. 1980 Oct;97(4):644–647. doi: 10.1016/s0022-3476(80)80032-1. [DOI] [PubMed] [Google Scholar]
  11. Dorson W., Jr, Baker E., Cohen M. L., Meyer B., Molthan M., Trump D., Elgas R. A perfusion system for infants. Trans Am Soc Artif Intern Organs. 1969;15:155–160. [PubMed] [Google Scholar]
  12. German J. C., Worcester C., Gazzaniga A. B., Huxtable R. F., Amlie R. N., Brahmbhatt N., Bartlett R. H. Technical aspects in the management of the meconium aspiration syndrome with extracorporeal circulation. J Pediatr Surg. 1980 Aug;15(4):378–383. doi: 10.1016/s0022-3468(80)80740-8. [DOI] [PubMed] [Google Scholar]
  13. Hallman M., Merritt T. A., Jarvenpaa A. L., Boynton B., Mannino F., Gluck L., Moore T., Edwards D. Exogenous human surfactant for treatment of severe respiratory distress syndrome: a randomized prospective clinical trial. J Pediatr. 1985 Jun;106(6):963–969. doi: 10.1016/s0022-3476(85)80253-5. [DOI] [PubMed] [Google Scholar]
  14. Hardesty R. L., Griffith B. P., Debski R. F., Jeffries M. R., Borovetz H. S. Extracorporeal membrane oxygenation. Successful treatment of persistent fetal circulation following repair of congenital diaphragmatic hernia. J Thorac Cardiovasc Surg. 1981 Apr;81(4):556–563. [PubMed] [Google Scholar]
  15. Hill J. D., O'Brien T. G., Murray J. J., Dontigny L., Bramson M. L., Osborn J. J., Gerbode F. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med. 1972 Mar 23;286(12):629–634. doi: 10.1056/NEJM197203232861204. [DOI] [PubMed] [Google Scholar]
  16. Klein M. D., Andrews A. F., Wesley J. R., Toomasian J., Nixon C., Roloff D., Bartlett R. H. Venovenous perfusion in ECMO for newborn respiratory insufficiency. A clinical comparison with venoarterial perfusion. Ann Surg. 1985 Apr;201(4):520–526. doi: 10.1097/00000658-198504000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kolobow T., Fumagalli R., Arosio P., Chen V., Buckhold D. K., Pierce J. E. The use of the extracorporeal membrane lung in the successful resuscitation of severely hypoxic and hypercapnic fetal lambs. Trans Am Soc Artif Intern Organs. 1982;28:365–368. [PubMed] [Google Scholar]
  18. Kolobow T., Moretti M. P., Mascheroni D., Chen V., Buckhold D., Pierce J. E., Fummagalli R., Ting P. Experimental meconium aspiration syndrome in the preterm fetal lamb: successful treatment using the extracorporeal artificial lung. Trans Am Soc Artif Intern Organs. 1983;29:221–226. [PubMed] [Google Scholar]
  19. Krummel T. M., Greenfield L. J., Kirkpatrick B. V., Mueller D. G., Ormazabal M., Salzberg A. M. Clinical use of an extracorporeal membrane oxygenator in neonatal pulmonary failure. J Pediatr Surg. 1982 Oct;17(5):525–531. doi: 10.1016/s0022-3468(82)80102-4. [DOI] [PubMed] [Google Scholar]
  20. Mault J. R., Kresowik T. F., Dechert R. E., Arnoldi D. K., Swartz R. D., Bartlett R. H. Continuous arteriovenous hemofiltration: the answer to starvation in acute renal failure? Trans Am Soc Artif Intern Organs. 1984;30:203–206. [PubMed] [Google Scholar]
  21. RASHKIND W. J., FREEMAN A., KLEIN D., TOFT R. W. EVALUATION OF A DISPOSABLE PLASTIC, LOW VOLUME, PUMPLESS OXYGENATOR AS A LUNG SUBSTITUTE. J Pediatr. 1965 Jan;66:94–102. doi: 10.1016/s0022-3476(65)80342-0. [DOI] [PubMed] [Google Scholar]
  22. Ronco C., Brendolan A., Bragantini L., Chiaramonte S., Fabris A., Feriani M., Frigiola A., La Greca G. Treatment of acute renal failure in the newborn by continuous arteriovenous hemofiltration. Trans Am Soc Artif Intern Organs. 1985;31:634–638. [PubMed] [Google Scholar]
  23. Toomasian J. M., Zwischenberger J. B., Oram A. D., DeSmet G. M., Bartlett R. H. The use of bound heparin in prolonged extracorporeal membrane oxygenation. Trans Am Soc Artif Intern Organs. 1984;30:133–136. [PubMed] [Google Scholar]
  24. Towne B. H., Lott I. T., Hicks D. A., Healey T. Long-term follow-up of infants and children treated with extracorporeal membrane oxygenation (ECMO): a preliminary report. J Pediatr Surg. 1985 Aug;20(4):410–414. doi: 10.1016/s0022-3468(85)80230-x. [DOI] [PubMed] [Google Scholar]
  25. Ware J. H., Epstein M. F. Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study. Pediatrics. 1985 Nov;76(5):849–851. [PubMed] [Google Scholar]
  26. Wetmore N. E., Bartlett R. H., Gazzaniga A. B., Haiduc N. J. Extracorporeal membrane oxygenation (ECMO): a team approach in critical care and life-support research. Heart Lung. 1979 Mar-Apr;8(2):288–295. [PubMed] [Google Scholar]
  27. Wetmore N., McEwen D., O'Connor M., Bartlett R. H. Defining indications for artificial organ support in respiratory failure. Trans Am Soc Artif Intern Organs. 1979;25:459–461. doi: 10.1097/00002480-197902500-00088. [DOI] [PubMed] [Google Scholar]
  28. White J. J., Andrews H. G., Risemberg H., Mazur D., Haller J. A., Jr Prolonged respiratory support in newborn infants with a membrane oxygenator. Surgery. 1971 Aug;70(2):288–296. [PubMed] [Google Scholar]
  29. Wung J. T., James L. S., Kilchevsky E., James E. Management of infants with severe respiratory failure and persistence of the fetal circulation, without hyperventilation. Pediatrics. 1985 Oct;76(4):488–494. [PubMed] [Google Scholar]
  30. Zapol W. M., Snider M. T., Hill J. D., Fallat R. J., Bartlett R. H., Edmunds L. H., Morris A. H., Peirce E. C., 2nd, Thomas A. N., Proctor H. J. Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979 Nov 16;242(20):2193–2196. doi: 10.1001/jama.242.20.2193. [DOI] [PubMed] [Google Scholar]
  31. Zwischenberger J. B., Toomasian J. M., Drake K., Andrews A. F., Kolobow T., Bartlett R. H. Total respiratory support with single cannula venovenous ECMO: double lumen continuous flow vs. single lumen tidal flow. Trans Am Soc Artif Intern Organs. 1985;31:610–615. [PubMed] [Google Scholar]
  32. Zwischenberger J. B., Toomasian J. M., Drake K., Andrews A. F., Kolobow T., Bartlett R. H. Total respiratory support with single cannula venovenous ECMO: double lumen continuous flow vs. single lumen tidal flow. Trans Am Soc Artif Intern Organs. 1985;31:610–615. [PubMed] [Google Scholar]

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