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Extracorporeal Membrane Oxygenation for Neonates

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Neonatology

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Abstract

Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonary bypass such that patients can be supported for a prolonged period, even up to weeks, until the patient’s respiratory and/or cardiac function recovers or definitive treatment is administered. A systematic review of results of 244 infants entered into randomized trials demonstrated that ECMO was associated with a reduction in mortality (relative risk 0.44, 95% CI 0.31–0.61) and the number needed to treat was three. Survival is best in neonates with meconium aspiration syndrome and worse in those with congenital diaphragmatic hernia. Chronic respiratory, neurological, and growth problems have been reported following ECMO. Overall, follow-up of infants into the largest randomized trial, the UK ECMO trial, showed at 7 years of age a continuing benefit of ECMO for the primary outcome of death or severe disability (relative risk 0.64, 95% CI 0.47–0.86; p = 0.004). While treatment was cost-effective in most diagnostic groups, the cost ratio for infants with CDH was far poorer. Subsequent advances in other respiratory support techniques for term and near-term infants, including high-frequency oscillation and nitric oxide, and, however, have reduced the number of cases referred for ECMO and altered the profile of such patients.

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Acknowledgments

We thank Dr Nicholas Barrett (Consultant in Critical Care at Guy’s and St Thomas’s Hospital NHS Foundation Trust) for providing data on the current mortality and Mrs Deirdre Gibbons for secretarial assistance.

The research was supported by the National Institute for Health Research (NIHR) Clinical Research Facility at Guy’s and St Thomas’ NHS Foundation Trust and NIHR Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

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Authors and Affiliations

  1. Division of Asthma, Allergy and Lung Biology, MRC Centre for Allergic Mechanisms of Asthma, King’s College London, London, UK

    Anne Greenough, Niovi Papalexopoulou, Munir Ahmed & Adam P. R. Smith

  2. NIHR Biomedical Centre at Guy’s and St Thomas NHS Foundation Trust and King’s College London, London, UK

    Anne Greenough

  3. NICU, King’s College Hospital, London, UK

    Anne Greenough

Authors
  1. Anne Greenough
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  2. Niovi Papalexopoulou
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  3. Munir Ahmed
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  4. Adam P. R. Smith
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Corresponding author

Correspondence to Anne Greenough .

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Editors and Affiliations

  1. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Giuseppe Buonocore

  2. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Rodolfo Bracci

  3. Liverpool Women’s Hospital Neonatal Unit, Liverpool, UK

    Michael Weindling

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Greenough, A., Papalexopoulou, N., Ahmed, M., Smith, A.P.R. (2018). Extracorporeal Membrane Oxygenation for Neonates. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-319-29489-6_211

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  • DOI: https://doi.org/10.1007/978-3-319-29489-6_211

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29487-2

  • Online ISBN: 978-3-319-29489-6

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