Original article
Neonatal extracorporeal life support: Impact of new therapies on survival

https://doi.org/10.1016/j.jpeds.2005.12.024Get rights and content

Objective

To evaluate the effects of pre-extracorporeal life support (ECLS) management with nitric oxide (NO), high frequency ventilation (HFV), and surfactant on mortality among neonates supported with ECLS.

Study design

Extracorporeal Life Support Organization (ELSO) data on 7017 neonates cannulated for respiratory reasons between 1996 and 2003 were analyzed using χ2, analysis of variance, and logistic regression.

Results

The use of ECLS declined by 26.6% over the study period with no significant change in mortality. Unadjusted ECLS mortality for NO-treated patients was lower than for infants not treated with NO (25.1% vs 28.6%, P = .0012) and for infants treated with surfactant than for infants not treated with surfactant (18.7% vs 30.3%, p <.0001.) Unadjusted mortality for HFV-treated patients was no different than for non-HFV-treated patients (26.0% vs 26.6%, P = .56). After adjusting for confounders (primary diagnosis, age at cannulation, ECMO year 1996-1999 vs 2000-2003), surfactant use was associated with decreased mortality. NO-treated neonates were less likely to have a pre-ECLS cardiopulmonary arrest than infants not treated with NO. NO, HFV, and surfactant were not associated with prolongation of ECLS or mechanical ventilation.

Conclusions

NO, HFV, and surfactant were not associated with increased mortality in neonates who require ECLS for hypoxic respiratory failure.

Section snippets

Methods

This study was approved by the Children’s Memorial Hospital Institutional Review Board. We queried the Extracorporeal Life Support Organization Registry, which collects demographic, clinical course, and outcomes data on every patient cannulated for ECLS from 99 ECLS centers in 13 countries worldwide.21 For this study, we analyzed the first-run information for all neonates with known survival information cannulated for ECLS for respiratory reasons between January 1, 1996 and December 31, 2003.

Results

During the study period, 7017 neonates were cannulated for ECLS for respiratory indications. From 1996 to 2003 the number of neonates cannulated for ECLS decreased by 26.6 % (Figure 1). Cannulation rates decreased the most for infants with sepsis (64.8%), RDS (55.8%), and MAS (45.9%), with smaller reductions noted for infants with PPHN (4.6%) and CDH (2.2%). Cannulation rates increased by 16.5% for infants with “other” diagnoses.

Mortality on ECLS was 26.4% during the study years, with similar

Discussion

This study reports on associations between mortality in ECLS patients and recently developed rescue therapies provided before the initiation of ECLS. Over the 8 years of the study, the use of NO, HFV, and surfactant all increased, accompanied by a marked decline in the total number of infants cannulated for ECLS because of MAS, RDS, and sepsis. Minimal changes were seen in the number of cannulated infants with PPHN and CDH, and the use of ECLS for other diagnoses increased. These data suggest

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