Skip to main content
SpringerLink
Log in

The Changing Pattern of Neonatal ECMO: Do we Really Need it?

  • Chapter
Intensive Care in Childhood

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 25))

  • 153 Accesses

Abstract

Extracorporeal membrane oxygenation (ECMO) is a modification of classic cardiopulmonary bypass (CPB) intended for the long term support of patients with life threatening cardiac and/or respiratory failure. In terms both of the numbers of patients treated and the success of those treatments, its most important application has been to neonatal patients with acute respiratory failure. Since the first successful neonatal ECMO case was reported in 1976 by Bartlett and colleagues [1], more than 13,000 patients have been supported with this technology, of whom more than 10,000 have been newborns (Table 1).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bartlett RH, Gazzaniga AB, Jefferies MR, Huxtable RF, Haiduc NJ, Fong SW. (1976) Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans. Am. Soc. Artif. Intern. Organs, 22:80–93.

    PubMed  CAS  Google Scholar 

  2. Shanley CJ, Hirschl RB, Schumacher RE, et al. (1994) Extracorporeal life support for neonatal respiratory failure. A 20-year experience. Annals of Surgery, 220:269–80: discussion 281–2.

    Article  PubMed  CAS  Google Scholar 

  3. Zwischenberger JB, Nguyen TT, Upp JR, Jr., et al. (1994) Complications of neonatal extracorporeal membrane oxygenation. Collective experience from the Extracorporeal Life Support Organization. J Thorac Cardiovasc Surg, 107:838–48: discussion 848–9.

    PubMed  CAS  Google Scholar 

  4. Glass P, Wagner AE, Papero PH, et al. (1995) Neurodevelopmental status at age five years of neonates treated with extracorporeal membrane oxygenation. Journal of Pediatrics, 127:447–457.

    Article  PubMed  CAS  Google Scholar 

  5. Rais-Bahrami K, Coffman C, Wagner A, Bulas D, Glass P, Short B. (1995) Outcome of ECMO vs. near miss ECMO patients at five years of age. 11th Annual CNMC Symmposium on ECMO and Advanced Therapies for Respiratory Failure. Keystone, CO, March 1995.

    Google Scholar 

  6. Anonymous (1993) Report of the Workshop on Diffusion of ECMO Technology. Extracorporeal Membrane Oxygenation. NIH Publication No. 93–3399, Rockville, MD.

    Google Scholar 

  7. Guyer B, Strobino DM, Ventura SJ, Singh GK. (1995) Annual summary of vital statistics-1994. Pediatrics, 96:1029–1039.(Abstract)

    PubMed  CAS  Google Scholar 

  8. Bartlett RH, Roloff DW, Cornell RG, Andrews AF, Dillon PW, Zwischenberger JB. (1985) Extracorporeal circulation in neonatal respiratory failure: A prospective randomized study. Pediatrics, 76:479–487.

    PubMed  CAS  Google Scholar 

  9. O’Rourke PP, Crone RK, Vacanti JP, et al. (1989) Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: a prospective randomized study. Pediatrics, 84:957–963.

    PubMed  Google Scholar 

  10. Schumacher RE. (1993) Extracorporeal membrane oxygenation. Will this therapy continue to be as efficacious in the future?. [Review]. Pediatr Clin North Am, 40:1005–1022.

    PubMed  CAS  Google Scholar 

  11. Wung J, James LS, Kilchevsky E, James E. (1985) Management of infants with severe respiratory failure and persistence of the fetal circulation, without hyperventilation. Pediatrics, 76:488–494.

    PubMed  CAS  Google Scholar 

  12. Long W, Zucker J, Kraybill E. (1995) Symposium on synthetic surfactant II: perspective and commentary. J Pediatr, 126:Sl-S4.(Abstract)

    Google Scholar 

  13. Bui KC, Walther FJ, David Cu R, Garg M, Warburton D. (1992) Phospholipid and surfactant protein A concentrations in tracheal aspirates from infants requiring extracorporeal membrane oxygenation. Journal of Pediatrics, 121:271–274.

    Article  PubMed  CAS  Google Scholar 

  14. Lotze A, Stroud CY, Soldin SJ. (1995) Serial lecithin/sphingomyelin ratios and surfactant/ albumin ratios in tracheal aspirates from term infants with respiratory failure receiving extracorporeal membrane oxygenation. Clinical Chemistry, 41:1182–1188.

    PubMed  CAS  Google Scholar 

  15. Findlay RD, Taeusch HW, Walther FJ. (1996) Surfactant replacement therapy for meconium aspiration syndrome. Pediatrics, 97:48–52.(Abstract)

    PubMed  CAS  Google Scholar 

  16. Lotze A, Knight GR, Martin GR, et al. (1993) Improved pulmonary outcome after exogenous surfactant therapy for respiratory failure in term infants requiring extracorporeal membrane oxygenation. J Pediatr, 122:261–268.

    Article  PubMed  CAS  Google Scholar 

  17. Lotze A, Knight GR, Anderson KD, et al. (1994) Surfactant (beractant) therapy for infants with congenital diaphragmatic hernia on ECMO: evidence of persistent surfactant deficiency. J Pediatr Surg, 29:407–412.

    Article  PubMed  CAS  Google Scholar 

  18. Lotze A, The Survanta in Term Infants Study Group. (1996) Survanta pre-ECMO trial: multicenter evaluation of Survanta in treatment of term infants with severe respiratory failure. 12th Annual CNMC Symmposium on ECMO and Advanced Therapies for Respiratory Failure. Keystone, CO, February 1996.

    Google Scholar 

  19. Bell RE, Kuehl TJ, Coalson JJ, et al. (1984) High frequency ventilation compared to conventional positive-pressure ventilation in the treatment of hyaline membrane disease in primates. Crit. Care Med. 12:764–767.

    Article  PubMed  CAS  Google Scholar 

  20. The HIFI Study Group. (1989) High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants. New England Journal of Medicine, 320:88–93.

    Article  Google Scholar 

  21. HO Study Group.(1993) Randomized study of high-frequency oscillatory ventilation in infants with severe respiratory distress syndrome. Journal of Pediatrics, 122:609–619.

    Article  Google Scholar 

  22. Ogawa Y, Miyasaka K, Kawano T, et al. (1993) A multicenter randomized trial of high frequency oscillatory ventilation as compared with conventional mechanical ventilation in preterm infants with respiratory failure. Early Human Development, 32:1–10.

    Article  PubMed  CAS  Google Scholar 

  23. Clark RH, Gerstmann DR, Null DM, Jr, demos RA. (1992) Prospective randomized comparison of high-frequency oscillatory and conventional ventilation in respiratory distress syndrome. Pediatrics, 89, 5–12.

    PubMed  CAS  Google Scholar 

  24. Imai Y, Kawano T, Miyasaka K, Takata M, Imai T, Okuyama K. (1994) Inflammatory chemical mediators during conventional ventilation and during high frequency oscillatory ventilation. American Journal of Respiratory & Critical Care Medicine, 150:1550–1554.

    CAS  Google Scholar 

  25. Cornish JD, Gerstmann DR, Clark RH, Carter JM, Null DM, Jr, demos RA. (1987) Extracorporeal membrane oxygenation and high-frequency oscillatory ventilation: potential therapeutic relationships. Crit. Care Med. 15:831–834.

    Article  PubMed  CAS  Google Scholar 

  26. Carlo WA, Beoglos A, Chatburn RL, Walsh MC, Martin RJ. (1989) High-frequency jet ventilation in neonatal pulmonary hypertension. Am. J. Dis. Child, 143:233–238.

    PubMed  CAS  Google Scholar 

  27. Kohelet D, Perlman M, Kirpalani H, Hanna G, Koren G. (1988) High-frequency oscillation in the rescue of infants with persistent pulmonary hypertension. Crit. Care Med. 16:510–516.

    Article  PubMed  CAS  Google Scholar 

  28. Tamura M, Tsuchida Y, Kawano T, et al. (1988) Piston-pump-type high frequency oscillatory ventilation for neonates with congenital diaphragmatic hernia: a new protocol. J Pediatr. Surg. 23:478–482.

    Article  PubMed  CAS  Google Scholar 

  29. Carter JM, Gerstmann DR, Clark RH, et al. (1990) High-frequency oscillatory ventilation and extracorporeal membrane oxygenation for the treatment of acute neonatal respiratory failure. Pediatrics, 85:159–164.

    PubMed  CAS  Google Scholar 

  30. Delemos R, Yoder B, Murnin D, Kinsella J, Clark R, Null D. (1992) The use of high-frequency oscillatory ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) in the management of the term/near term infant with respiratory failure. Early Human Development, 29:299–303.

    Article  PubMed  CAS  Google Scholar 

  31. Varnholt V, Lasch P, Suske G, Kachel W, Brands W. (1992) High frequency oscillatory ventilation and extracorporeal membrane oxygenation in severe persistent pulmonary hypertension of the newborn. Eur. J Pediatr, 151:769–774.

    Article  PubMed  CAS  Google Scholar 

  32. Miguet D, Cagnin S, Claris O, Lapillonne A, Salle BL. (1994) [Persistence of fetal circulation and high frequency oscillation]. [French]. Cahiers d Anesthesiologie, 42:319–324.

    PubMed  CAS  Google Scholar 

  33. Miguet D, Claris O, Lapillonne A, Bakr A, Chappuis JP, Salle BL. (1994) Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia. Critical Care Medicine, 22: S77–82.

    Article  PubMed  CAS  Google Scholar 

  34. Clark RH, Yoder BA, Sell MS. (1994) Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation. J Pediatr, 124:447–454.

    Article  PubMed  CAS  Google Scholar 

  35. Bond DM, Froese AB. (1993) Volume recruitment maneuvers are less deleterious than persistent low lung volumes in the atelectasis-prone rabbit lung during high-frequency oscillation. Crit. Care Med. 21:402–412.

    Article  PubMed  CAS  Google Scholar 

  36. Arnold JH, Hanson JH, Toro-Figuero LO, Gutierrez J, Berens RJ, Anglin DL. (1994) Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Critical Care Medicine, 22:1530–1539.

    PubMed  CAS  Google Scholar 

  37. Kinsella JP, Mueston J A, Rosenberg AA, et al. (1992) Hemodynamic effects of exogenous nitric oxide in ovine transitional pulmonary circulation. American Journal of Physiology, 263:H875-H880.

    PubMed  CAS  Google Scholar 

  38. Roberts JD, Jr., Chen TY, Kawai N, et al. (1993) Inhaled nitric oxide reverses pulmonary vasoconstriction in the hypoxic and acidotic newborn lamb. Circulation Research, 72:246–254.

    PubMed  CAS  Google Scholar 

  39. Roberts JD, Polaner DM, Lang P, Zapol WM. (1992) Inhaled nitric oxide in persistent pulmonary hypertension of the newborn. Lancet, 340:818–819.

    Article  PubMed  CAS  Google Scholar 

  40. Kinsella JP, Neish SR, Shaffer E, Abman SH. (1992) Low-dose inhalation nitric oxide in persistent pulmonary hypertension of the newborn. Lancet, 340:819–820.

    Article  PubMed  CAS  Google Scholar 

  41. Abman SH, Kinsella JP, Schaffer MS, Wilkening RB. (1993) Inhaled nitric oxide in the management of a premature newborn with severe respiratory distress and pulmonary hypertension. Pediatrics, 92, 606–609.

    PubMed  CAS  Google Scholar 

  42. Kinsella JP, Toews WH, Henry D, Abman SH. (1993) Selective and sustained pulmonary vasodilation with inhalational nitric oxide therapy in a child with idiopathic pulmonary hypertension. Journal of Pediatrics, 122:803–806.

    Article  PubMed  CAS  Google Scholar 

  43. Kinsella JP, Neish SR, Ivy DD, Shaffer E, Abman SH. (1993) Clinical responses to prolonged treatment of persistent pulmonary hypertension of the newborn with low doses of inhaled nitric oxide [see comments]. Journal of Pediatrics, 123:103–108.

    Article  PubMed  CAS  Google Scholar 

  44. Kinsella JP, Abman SH. (1993) Inhalational nitric oxide therapy for persistent pulmonary hypertension of the newborn. Pediatrics, 91:997–998.

    PubMed  CAS  Google Scholar 

  45. Abman SH. (1994) Pathogenesis and treatment of neonatal and postnatal pulmonary hypertension. [Review]. Current Opinion in Pediatrics, 6:239–247.

    Article  PubMed  CAS  Google Scholar 

  46. Roberts JD, Jr. (1993) Inhaled nitric oxide for treatment of pulmonary artery hypertension in the newborn and infant. [Review]. Critical Care Medicine, 21:S374–6.

    Article  PubMed  Google Scholar 

  47. Roberts JD, Jr., Lang P, Bigatello LM, Vlahakes GJ, Zapol WM. (1993) Inhaled nitric oxide in congenital heart disease. Circulation, 87:447–453.

    PubMed  Google Scholar 

  48. Karamanoukian HL, Glick PL, Zayek M, et al. (1994) Inhaled nitric oxide in congenital hypoplasia of the lungs due to diaphragmatic hernia or oligohydramnios. Pediatrics, 94:715–718.

    PubMed  CAS  Google Scholar 

  49. Karamanoukian HL, Glick PL, Wilcox DT, Rossman JE, Holm BA, Morin FC. (1995) Pathophysiology of congenital diaphragmatic hernia. VIII: Inhaled nitric oxide requires exogenous surfactant therapy in the lamb model of congenital diaphragmatic hernia. Journal of Pediatric Surgery, 30:1–4.

    Article  PubMed  CAS  Google Scholar 

  50. Rossaint R, Gerlach H, Falke KJ. (1994) Inhalation of nitric oxide-a new approach in severe ARDS. [Review]. European Journal of Anaesthesiology, 11:43–51.

    PubMed  CAS  Google Scholar 

  51. Finer NN, Etches PC, Kamstra B, Tierney AJ, Peliowski A, Ryan CA. (1994) Inhaled nitric oxide in infants referred for extracorporeal membrane oxygenation: dose response. J Pediatr, 124:302–308.

    Article  PubMed  CAS  Google Scholar 

  52. Peliowski A, Finer NN, Etches PC, Tierney AJ, Ryan CA. (1995) Inhaled nitric oxide for premature infants after prolonged rupture of the membranes. Journal of Pediatrics, 126:450–453.

    Article  PubMed  CAS  Google Scholar 

  53. Gerlach H, Pappert D, Lewandowski K, Rossaint R, Falke KJ. (1993) Long-term inhalation with evaluated low doses of nitric oxide for selective improvement of oxygenation in patients with adult respiratory distress syndrome. Intensive Care Med 19:443–449.

    Article  PubMed  CAS  Google Scholar 

  54. Gerlach H, Rossaint R, Pappert D, Falke KJ. (1993) Time-course and dose-response of nitric oxide inhalation for systemic oxygenation and pulmonary hypertension in patients with adult respiratory distress syndrome. European Journal of Clinical Investigation, 23:499–502.

    Article  PubMed  CAS  Google Scholar 

  55. Stark AR, Davidson D. (1995) Inhaled nitric oxide for persistent pulmonary hypertension of the newborn: implications and strategy for future “high-tech” neonatal clinical trials. [Review]. Pediatrics, 96:1147–1151.

    PubMed  CAS  Google Scholar 

  56. Abman SH, Kinsella JP. (1995) Inhaled nitric oxide for persistent pulmonary hypertension of the newborn: the physiology matters: [comment]. [Review]. Pediatrics, 96:1153–1155.

    PubMed  CAS  Google Scholar 

  57. Kornhauser MS, Cullen JA, Baumgart S, Mee LJ, Gross GW, Spitzer AR. (1994) Risk factors for bronchopulmonary dysplasia after extracorporeal membrane oxygenation. Archives of Pediatrics & Adolescent Medicine, 148:820–825.

    CAS  Google Scholar 

  58. Leach CL, Fuhrman BP, Morin FC, 3rd, Rath MG. (1993) Perfluorocarbon-associated gas exchange (partial liquid ventilation) in respiratory distress syndrome: a prospective, randomized, controlled study. Critical Care Medicine, 21:1270–1278.

    Article  PubMed  CAS  Google Scholar 

  59. Fuhrman BP. (1990) Perfluorocarbon liquid ventilation: the first human trial. Journal of Pediatrics, 117:73–74.

    Article  PubMed  CAS  Google Scholar 

  60. Gross GW, Greenspan JS, Fox WW, Rubenstein SD, Wolfson MR, Shaffe H. (1995) Use of liquid ventilation with perflubron during extracorporeal membrane oxygenation: chest radiographic appearances. Radiology, 194:717–720.

    PubMed  CAS  Google Scholar 

  61. Hirschl RB, Tooley R, Parent AC, Johnson K, Bartlett RH. (1995) Improvement of gas exchange, pulmonary function, and lung injury with partial liquid ventilation. A study model in a setting of severe respiratory failure. Chest, 108:500–508.

    Google Scholar 

  62. Tutuncu AS, Akpir K, Mulder P, Erdmann W, Lachmann B. (1993) Intratracheal perfluorocarbon administration as an aid in the ventilatory management of respiratory distress syndrome. Anesthesiology, 79:1083–1093.

    Article  PubMed  CAS  Google Scholar 

  63. Tutuncu AS, Faithfull NS, Lachmann B. (1993) Comparison of ventilatory support with intratracheal perfluorocarbon administration and conventional mechanical ventilation in animals with acute respiratory failure. American Review of Respiratory Disease, 148:785–792.

    Article  PubMed  CAS  Google Scholar 

  64. Lowe CA, Shaffer TH. (1986) Pulmonary vascular resistance in the fluorocarbon-filled lung. J Appl Physiol, 60:154–159.

    PubMed  CAS  Google Scholar 

  65. Lane T, Smith D, Wancewicz E, Funk R. (1992) Inhibition of endotoxin-mediated activation of endothelial cells by a perfluorocarbon emulsion. Biomater. Artif Cells Immobilization. Biotechnol. 20:1051–1057.

    Article  CAS  Google Scholar 

  66. Hirschl RB, Parent A, Tooley R, Shaffer T, Wolfson M, Bartlett RH. (1994) Lung management with perfluorocarbon liquid ventilation improves pulmonary function and gas exchange during extracorporeal membrane oxygenation (ECMO). Artificial Cells, Blood Substitutes, & Immobilization Biotechnology, 22:1389–1396.

    Article  CAS  Google Scholar 

  67. Leach CL, Holm B, Morin FC, 3rd, et al. (1995) Partial liquid ventilation in premature lambs with respiratory distress syndrome: efficacy and compatibility with exogenous surfactant. Journal of Pediatrics, 126:412–420.

    Article  PubMed  CAS  Google Scholar 

  68. Hirschl RB, Pranikoff T, Gauger P, et al. (1995) Liquid ventilation in adults, children, and full-term neonates. Lancet, 346, 1201–1202.

    Article  PubMed  CAS  Google Scholar 

  69. Kinsella JP, Abman SH. (1995) Recent developments in the pathophysiology and treatment of persistent pulmonary hypertension of the newborn. [Review]. Journal of Pediatrics, 126:853–864.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. J. D. Cornish
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Dept. of Pediatric Surgery, Pediatric Surgical Intensive Care Unit, Sophia Children’s Hospital, University Hospital Rotterdam, Dr. Molewaterplein 60, NL-3015, GJ Rotterdam, The Netherlands

    Dick Tibboel

  2. Dept. of Pediatrics, Subdivision of Pediatric, Intensive Care, Sophia Children’s Hospital, University Hospital Rotterdam, Dr. Molewaterplein 60, NL-3015, GJ Rotterdam, The Netherlands

    Edwin van der Voort

Rights and permissions

Reprints and permissions

Copyright information

© 1996 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Cornish, J.D. (1996). The Changing Pattern of Neonatal ECMO: Do we Really Need it?. In: Tibboel, D., van der Voort, E. (eds) Intensive Care in Childhood. Update in Intensive Care and Emergency Medicine, vol 25. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-80227-0_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-80227-0_25

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-80229-4

  • Online ISBN: 978-3-642-80227-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation