Introduction
Extracorporeal membrane oxygenation (ECMO) has been recognised as effective in supporting newborn infants with acute hypoxemic respiratory failure due to pulmonary hypertension. The aim of this retrospective study was to document changing trends in the use of pre-ECMO novel therapies (surfactant, high-frequency oscillatory ventilation and inhaled nitric oxide) over the past decade in one of the regional ECMO centre in UK.
Methods and patients
All neonatal ECMO patients treated between October 1992 and August 2001 were retrospectively reviewed. Pre-ECMO treatments were analysed separately during 1992–1995, 1995–1998 and 1998–2001.
Results
A total of 128 neonates received ECMO. Thirty-two patients were excluded due to major associated congenital anomalies. Of the remaining 96 patients, 64 had meconium aspiration syndrome and 32 had other causes. Table 1 shows the distribution of pre-ECMO therapies in meconium aspiration syndrome group and patients' outcome received ECMO.
Table 1.
| 1992–1995 | 1995–1998 | 1998–2001 | |
|---|---|---|---|
| Numbers of ECMO patients | 12 | 28 | 24 |
| Surfactant (%) | 50 | 75 | 83.3 |
| High-frequency oscillatory ventilation (%) | 58.3 | 89.3 | 95.8 |
| Inhaled nitric oxide (%) | 41.7 | 92.9 | 100 |
| Time on ECMO (hours) | 113.9 | 151.4 | 125.2 |
| Survival (%) | 91.7 | 92.9 | 83.3 |
Conclusion
This data suggests a steady increase in the use of pre-ECMO conventional therapies over the past decade in our regional ECMO centre. However, this has not been associated with a significant reduction in the use of ECMO nationally nor in the ventilated time pre-ECMO, length of time or patient outcome on ECMO.