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ECMO: Regional Evaluation of Need and Applicability of Selection Criteria

ECMO: Regional Evaluation of Need and Applicability of Selection Criteria Abstract • The need and indications for neonatal extracorporeal membrane oxygenation (ECMO) are controversial. The need for ECMO in two New England states was studied through a review of deaths due to respiratory failure in nearand full-term infants. Vermont averaged 2.4 and Maine averaged 7.4 deaths annually. Neither state demonstrated sufficient respiratory deaths to establish ECMO capability. The number of "potential" ECMO candidates, based on published selection criteria, was studied, and the applicability of criteria was evaluated. A two-year review revealed 16 potential candidates from Maine and 19 from Vermont. No criterion accurately identified nonsurvivors of conventional ventilatory therapy. Only one criterion in one institution demonstrated an association with chronic lung disease. The data demonstrated that published ECMO selection criteria were not applicable in different populations. (AJDC 1988;142:1320-1324) References 1. Ortiz RM, Cilley RE, Bartlett RH: Extracorporeal membrane oxygenation in pediatric respiratory failure . Pediatr Clin North Am 1987; 34:39-46. 2. Short BL, Miller MK, Anderson KD: Extracorporeal membrane oxygenation in the management of respiratory failure in the newborn . Clin Perinatol 1987;14:737-748. 3. Bartlett RH, Roloff DW, Cornell RG, et al: Extracorporeal circulation in neonatal respiratory failure: A prospective randomized study . Pediatrics 1985;76:479-487. 4. Bartlett RH, Toomasian J, Roloff D, et al: Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure—100 cases . Ann Surg 1986;204:39-47.Crossref 5. Miller MK, Short BL, Glass P, et al: Outcome of 100 infants treated with extracorporeal membrane oxygenation (ECMO) , abstracted. Pediatr Res 1987;21:369. 6. Bartlett RH: ECMO Central Registry . Ann Arbor, Mich, University of Michigan, February 1988. 7. Paneth N, Wallenstein S: Extracorporeal membrane oxygenation and play the winner rule . Pediatrics 1985;76:622-623. 8. Ware JH, Epstein MF: Extracorporeal circulation in neonatal respiratory failure: A prospective randomized study . Pediatrics 1985;76: 849-850. 9. Dworetz AR, Fernanado RM, Sabo B, et al: Survival in infants with persistent pulmonary hypertension (PPHTN) without extracorporeal membrane oxygenation (ECMO) , abstracted. Pediatr Res 1987;21:360.Crossref 10. Shelton CK, Gonzales F: Patient selection for extracorporeal membrane oxygenation (ECMO): Importance of individual institutional reviews , abstracted. Pediatr Res 1987;21:376. 11. Marsh TD, Wilderson SA, Cook LN: ECMO selection criteria: Pao2 vs AaDo2 . Pediatrics 1988;82:162-166. 12. Schapira D, Solimano A: Is extracorporeal membrane oxygenation (ECMO) necessary to reduce mortality and morbidity in patients with meconium aspiration syndrome (MAS)? abstracted. Pediatr Res 1988;22:424. 13. Davis JM, Spitzer AR, Cox C, et al: Predicting survival in infants with persistent pulmonary hypertension of the newborn , in Lucey JF: Two Great Debates in Neonatology, Ross Laboratories Special Conference . 1987, p 114. 14. Southgate WM, Kanto WP: Defining the need for ECMO in Georgia , in Two Great Debates in Neonatology, Ross Laboratories Special Conference , 1987, pp 124-125. 15. Towne BH, Lott IT, Hicks DA, et al: Longterm follow-up of infants and children treated with extracorporeal membrane oxygenation (ECMO): A preliminary report . J Pediatr Surg 1985;20:410-414.Crossref 16. Sell LL, Cullen ML, Whittlesey GC, et al: Hemorrhagic complications during extracorporeal membrane oxygenation: Prevention and treatment . J Pediatr Surg 1986;21:10871091.Crossref 17. Schumacher RE, Barks JDE, Johnston MV, et al: Right-sided brain lesions in infants following unilateral carotid ligation for extracorporeal membrane oxygenation , abstracted. Pediatr Res 1987;21:375. 18. Ichord R, Kapur S, Short BL, et al: Neuropathologic findings in neonatal ECMO , abstracted. Pediatr Res 1988;22:411. 19. Glass P, Short BL: ECMO: Developmental outcome at age 2 , abstracted. Pediatr Res 1988; 22:447. 20. Reznik VM, Griswold WR, Telsey AL, et al: Systemic hypertension in infants after treatment with extracorporeal membrane oxygenation (ECMO) , abstracted. Pediatr Res 1988; 22:423. 21. Short BL, Anderson K, Arensman R, et al (ECMO Standards Committee): Guidelines for neonatal ECMO programs , in: Two Great Debates in Neonatology, Ross Laboratories Special Conference . 1987, pp 27-65. 22. Loe WA, Graves ED, Ochsner JL, et al: Extracorporeal membrane oxygenation for newborn respiratory failure . J Pediatr Surg 1985;20: 684-688.Crossref 23. Trento A, Griffith BP, Hardesty RL: Extracorporeal membrane oxygenation experience at the University of Pittsburgh . Ann Thorac Surg 1986;42:56-59.Crossref 24. Weber TR, Pennington DG, Connors R, et al: Extracorporeal membrane oxygenation for newborn respiratory failure . Ann Thorac Surg 1986;42:529-535.Crossref 25. Redmond CR, Graves ED, Falterman KW, et al: Extracorporeal membrane oxygenation for respiratory and cardiac failure in infants and children . J Thorac Cardiovasc Surg 1987;93: 199-204. 26. Wung JT, James LS, Kilchevsky E, et al: Management of infants with severe respiratory failure and persistence of fetal circulation, without hyperventilation . Pediatrics 1985;76:488-494. 27. Bartlett RH, Gazzaniga AB, Fong SW, et al: Extracorporeal membrane oxygenator support for cardiopulmonary failure: Experience in 28 cases . J Thorac Cardiovasc Surg 1977;73: 375-386. 28. Bartlett RH, Gazzaniga AB, Huxtable RF, et al: Extracorporeal circulation (ECMO) in neonatal respiratory failure . J Thorac Cardiovasc Surg 1977;74:826-833. 29. Wetmore N, McEwen D, O'Connor M, et al: Defining indications for artificial organ support in respiratory failure . Trans Am Soc Artif Intern Organs 1979;25:459-461.Crossref 30. Hardesty RL, Griffith BP, Debski RF, et al: Extracorporeal membrane oxygenation: Successful treatment of persistent fetal circulation following repair of congenital diaphragmatic hernia . J Thorac Cardiovasc Surg 1981;81:556563. 31. Bartlett RH, Andrews AF, Toomasian JM, et al: Extracorporeal membrane oxygenation for newborn respiratory failure: Forty-five cases . Surgery 1982;92:425-433. 32. Krummel TM, Greenfield LJ, Kirkpatrick BV, et al: Clinical use of an extracorporeal membrane oxygenator in neonatal pulmonary failure . J Pediatr Surg 1982;17:525-531.Crossref 33. Kirkpatrick BV, Krummel TM, Mueller DG, et al: Use of extracorporeal membrane oxygenation for respiratory failure in term infants . Pediatrics 1983;72:872-876. 34. Krummel TM, Greenfield LJ, Kirkpatrick BV, et al: Alveolar-arterial oxygen gradients vs the neonatal pulmonary insufficiency index for prediction of mortality in ECMO candidates . J Pediatr Surg 1984;19:380-384.Crossref 35. Beck R, Anderson KD, Pearson GD, et al: Criteria for extracorporeal membrane oxygenation in a population of infants with persistent pulmonary hypertension of the newborn . J Pediatr Surg 1986;21:297-302.Crossref 36. Ortega M, Ramos A, Atkinson J, et al: Oxygenation index can predict outcome in neonates who are candidates for extracorporeal membrane oxygenation , abstracted. Pediatr Res 1987;21:462.Crossref 37. Purohit DM, Patrick CH: ECMO: Comments on selection criteria , in: Two Great Debates in Neonatology, Ross Laboratories Special Conference. 1987, pp 126-128. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

ECMO: Regional Evaluation of Need and Applicability of Selection Criteria

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1988.02150120074044
Publisher site
See Article on Publisher Site

Abstract

Abstract • The need and indications for neonatal extracorporeal membrane oxygenation (ECMO) are controversial. The need for ECMO in two New England states was studied through a review of deaths due to respiratory failure in nearand full-term infants. Vermont averaged 2.4 and Maine averaged 7.4 deaths annually. Neither state demonstrated sufficient respiratory deaths to establish ECMO capability. The number of "potential" ECMO candidates, based on published selection criteria, was studied, and the applicability of criteria was evaluated. A two-year review revealed 16 potential candidates from Maine and 19 from Vermont. No criterion accurately identified nonsurvivors of conventional ventilatory therapy. Only one criterion in one institution demonstrated an association with chronic lung disease. The data demonstrated that published ECMO selection criteria were not applicable in different populations. (AJDC 1988;142:1320-1324) References 1. Ortiz RM, Cilley RE, Bartlett RH: Extracorporeal membrane oxygenation in pediatric respiratory failure . Pediatr Clin North Am 1987; 34:39-46. 2. Short BL, Miller MK, Anderson KD: Extracorporeal membrane oxygenation in the management of respiratory failure in the newborn . Clin Perinatol 1987;14:737-748. 3. Bartlett RH, Roloff DW, Cornell RG, et al: Extracorporeal circulation in neonatal respiratory failure: A prospective randomized study . Pediatrics 1985;76:479-487. 4. Bartlett RH, Toomasian J, Roloff D, et al: Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure—100 cases . Ann Surg 1986;204:39-47.Crossref 5. Miller MK, Short BL, Glass P, et al: Outcome of 100 infants treated with extracorporeal membrane oxygenation (ECMO) , abstracted. Pediatr Res 1987;21:369. 6. Bartlett RH: ECMO Central Registry . Ann Arbor, Mich, University of Michigan, February 1988. 7. Paneth N, Wallenstein S: Extracorporeal membrane oxygenation and play the winner rule . Pediatrics 1985;76:622-623. 8. Ware JH, Epstein MF: Extracorporeal circulation in neonatal respiratory failure: A prospective randomized study . Pediatrics 1985;76: 849-850. 9. Dworetz AR, Fernanado RM, Sabo B, et al: Survival in infants with persistent pulmonary hypertension (PPHTN) without extracorporeal membrane oxygenation (ECMO) , abstracted. Pediatr Res 1987;21:360.Crossref 10. Shelton CK, Gonzales F: Patient selection for extracorporeal membrane oxygenation (ECMO): Importance of individual institutional reviews , abstracted. Pediatr Res 1987;21:376. 11. Marsh TD, Wilderson SA, Cook LN: ECMO selection criteria: Pao2 vs AaDo2 . Pediatrics 1988;82:162-166. 12. Schapira D, Solimano A: Is extracorporeal membrane oxygenation (ECMO) necessary to reduce mortality and morbidity in patients with meconium aspiration syndrome (MAS)? abstracted. Pediatr Res 1988;22:424. 13. Davis JM, Spitzer AR, Cox C, et al: Predicting survival in infants with persistent pulmonary hypertension of the newborn , in Lucey JF: Two Great Debates in Neonatology, Ross Laboratories Special Conference . 1987, p 114. 14. Southgate WM, Kanto WP: Defining the need for ECMO in Georgia , in Two Great Debates in Neonatology, Ross Laboratories Special Conference , 1987, pp 124-125. 15. Towne BH, Lott IT, Hicks DA, et al: Longterm follow-up of infants and children treated with extracorporeal membrane oxygenation (ECMO): A preliminary report . J Pediatr Surg 1985;20:410-414.Crossref 16. Sell LL, Cullen ML, Whittlesey GC, et al: Hemorrhagic complications during extracorporeal membrane oxygenation: Prevention and treatment . J Pediatr Surg 1986;21:10871091.Crossref 17. Schumacher RE, Barks JDE, Johnston MV, et al: Right-sided brain lesions in infants following unilateral carotid ligation for extracorporeal membrane oxygenation , abstracted. Pediatr Res 1987;21:375. 18. Ichord R, Kapur S, Short BL, et al: Neuropathologic findings in neonatal ECMO , abstracted. Pediatr Res 1988;22:411. 19. Glass P, Short BL: ECMO: Developmental outcome at age 2 , abstracted. Pediatr Res 1988; 22:447. 20. Reznik VM, Griswold WR, Telsey AL, et al: Systemic hypertension in infants after treatment with extracorporeal membrane oxygenation (ECMO) , abstracted. Pediatr Res 1988; 22:423. 21. Short BL, Anderson K, Arensman R, et al (ECMO Standards Committee): Guidelines for neonatal ECMO programs , in: Two Great Debates in Neonatology, Ross Laboratories Special Conference . 1987, pp 27-65. 22. Loe WA, Graves ED, Ochsner JL, et al: Extracorporeal membrane oxygenation for newborn respiratory failure . J Pediatr Surg 1985;20: 684-688.Crossref 23. Trento A, Griffith BP, Hardesty RL: Extracorporeal membrane oxygenation experience at the University of Pittsburgh . Ann Thorac Surg 1986;42:56-59.Crossref 24. Weber TR, Pennington DG, Connors R, et al: Extracorporeal membrane oxygenation for newborn respiratory failure . Ann Thorac Surg 1986;42:529-535.Crossref 25. Redmond CR, Graves ED, Falterman KW, et al: Extracorporeal membrane oxygenation for respiratory and cardiac failure in infants and children . J Thorac Cardiovasc Surg 1987;93: 199-204. 26. Wung JT, James LS, Kilchevsky E, et al: Management of infants with severe respiratory failure and persistence of fetal circulation, without hyperventilation . Pediatrics 1985;76:488-494. 27. Bartlett RH, Gazzaniga AB, Fong SW, et al: Extracorporeal membrane oxygenator support for cardiopulmonary failure: Experience in 28 cases . J Thorac Cardiovasc Surg 1977;73: 375-386. 28. Bartlett RH, Gazzaniga AB, Huxtable RF, et al: Extracorporeal circulation (ECMO) in neonatal respiratory failure . J Thorac Cardiovasc Surg 1977;74:826-833. 29. Wetmore N, McEwen D, O'Connor M, et al: Defining indications for artificial organ support in respiratory failure . Trans Am Soc Artif Intern Organs 1979;25:459-461.Crossref 30. Hardesty RL, Griffith BP, Debski RF, et al: Extracorporeal membrane oxygenation: Successful treatment of persistent fetal circulation following repair of congenital diaphragmatic hernia . J Thorac Cardiovasc Surg 1981;81:556563. 31. Bartlett RH, Andrews AF, Toomasian JM, et al: Extracorporeal membrane oxygenation for newborn respiratory failure: Forty-five cases . Surgery 1982;92:425-433. 32. Krummel TM, Greenfield LJ, Kirkpatrick BV, et al: Clinical use of an extracorporeal membrane oxygenator in neonatal pulmonary failure . J Pediatr Surg 1982;17:525-531.Crossref 33. Kirkpatrick BV, Krummel TM, Mueller DG, et al: Use of extracorporeal membrane oxygenation for respiratory failure in term infants . Pediatrics 1983;72:872-876. 34. Krummel TM, Greenfield LJ, Kirkpatrick BV, et al: Alveolar-arterial oxygen gradients vs the neonatal pulmonary insufficiency index for prediction of mortality in ECMO candidates . J Pediatr Surg 1984;19:380-384.Crossref 35. Beck R, Anderson KD, Pearson GD, et al: Criteria for extracorporeal membrane oxygenation in a population of infants with persistent pulmonary hypertension of the newborn . J Pediatr Surg 1986;21:297-302.Crossref 36. Ortega M, Ramos A, Atkinson J, et al: Oxygenation index can predict outcome in neonates who are candidates for extracorporeal membrane oxygenation , abstracted. Pediatr Res 1987;21:462.Crossref 37. Purohit DM, Patrick CH: ECMO: Comments on selection criteria , in: Two Great Debates in Neonatology, Ross Laboratories Special Conference. 1987, pp 126-128.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Dec 1, 1988

References