Expanded Application of Extracorporeal Membrane Oxygenation in a Pediatric Surgery Practice

Overview

Journal Ann Surg

Specialty General Surgery

Date 2003 Jun 11

PMID 12796572

Citations 5

Authors

Max Raymond Langham Jr

David William Kays

Elizabeth Ann Beierle

Mike K Chen

Karla Stringfellow

James Lewis Talbert

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the breadth of application and resulting outcomes in a university-based extracorporeal membrane oxygenation (ECMO) program directed by pediatric surgeons.

Summary Background Data: Several randomized control trials have supported the use of ECMO in neonates with respiratory failure. No comparable data exist for older children and young adults who may be afflicted with a variety of uncommon conditions. The indications for ECMO in these patients remain controversial.

Methods: Patient data were recorded prospectively and reported to the Extracorporeal Life Support Organization. These data were analyzed by indications and outcomes on all patients treated since the inception of the program.

Results: Two hundred sixteen patients were treated with 225 courses of ECMO. Neonates (188 [87%]) outnumbered 28 older patients (aged 6 weeks to 22 years). Overall, 174 patients survived (81%). Sixty-four of 65 (98.5%) neonates with meconium aspiration syndrome survived. ECMO support after heart (3), lung (2), heart-lung (1), and liver (1) transplant yielded a 57% survival to discharge. ECMO also resulted in survival of patients with uncommon conditions, including severe asthma (1), hydrocarbon aspiration (1/2), congestive heart failure due to a cerebral arteriovenous malformation (1), tracheal occlusion incurred during endoscopic stent manipulation (2), meningitis (1), and viral pneumonia (3/5).

Conclusions: ECMO can potentially eliminate mortality for meconium aspiration syndrome. Survival for other causes of respiratory failure in neonates and older children, while not as dramatic, still surpasses that anticipated with conventional therapy. Moreover, survival of transplant patients has been comparable to that achieved in other children.

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References

Masiakos P, Islam S, Doody D, Schnitzer J, Ryan D . Extracorporeal membrane oxygenation for nonneonatal acute respiratory failure. Arch Surg. 1999; 134(4):375-9; discussion 379-80. DOI: 10.1001/archsurg.134.4.375. View

White J, Andrews H, Risemberg H, Mazur D, HALLER Jr J . Prolonged respiratory support in newborn infants with a membrane oxygenator. Surgery. 1971; 70(2):288-96. View

Chan C, Chen Y, Ko W, Wang S, Chiu I, Lee Y . Extracorporeal membrane oxygenation support for single lung transplantation in a patient with primary pulmonary hypertension. J Heart Lung Transplant. 1998; 17(3):325-7. View

Aharon A, Drinkwater Jr D, Churchwell K, Quisling S, Reddy V, Taylor M . Extracorporeal membrane oxygenation in children after repair of congenital cardiac lesions. Ann Thorac Surg. 2002; 72(6):2095-101; discussion 2101-2. DOI: 10.1016/s0003-4975(01)03209-x. View

Reickert C, Schreiner R, Bartlett R, Hirschl R . Percutaneous access for venovenous extracorporeal life support in neonates. J Pediatr Surg. 1998; 33(2):365-9. DOI: 10.1016/s0022-3468(98)90464-x. View

Kays D, Langham Jr M, Ledbetter D, TALBERT J . Detrimental effects of standard medical therapy in congenital diaphragmatic hernia. Ann Surg. 1999; 230(3):340-8; discussion 348-51. PMC: 1420879. DOI: 10.1097/00000658-199909000-00007. View

Connolly K, McGuirt Jr W . Elective extracorporeal membrane oxygenation: an improved perioperative technique in the treatment of tracheal obstruction. Ann Otol Rhinol Laryngol. 2001; 110(3):205-9. DOI: 10.1177/000348940111000301. View

Sreenan C, Osiovich H . Neonatal pertussis requiring extracorporeal membrane oxygenation. Pediatr Surg Int. 2001; 17(2-3):201-3. DOI: 10.1007/s003830000429. View

Knight G, Dudell G, Evans M, Grimm P . A comparison of venovenous and venoarterial extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure. Crit Care Med. 1996; 24(10):1678-83. DOI: 10.1097/00003246-199610000-00013. View

10.

Marks S, Nicholl R . The reduction in the need for ECMO by using surfactant in meconium aspiration syndrome. J Pediatr. 1999; 135(2 Pt 1):267-8. DOI: 10.1016/s0022-3476(99)70040-5. View

11.

LINDEN V, Karlen J, Olsson M, Palmer K, EHREN H, Henter J . Successful extracorporeal membrane oxygenation in four children with malignant disease and severe Pneumocystis carinii pneumonia. Med Pediatr Oncol. 1999; 32(1):25-31. DOI: 10.1002/(sici)1096-911x(199901)32:1<25::aid-mpo6>3.0.co;2-x. View

12.

Zenati M, Pham S, Keenan R, Griffith B . Extracorporeal membrane oxygenation for lung transplant recipients with primary severe donor lung dysfunction. Transpl Int. 1996; 9(3):227-30. DOI: 10.1007/BF00335390. View

13.

Morneault L, Johnston A, Perreault T . Management of acute airway obstruction using extracorporeal membrane oxygenation. ASAIO J. 1996; 42(4):321-3. View

14.

Ishino K, Weng Y, Alexi-Meskishvili V, Loebe M, Uhlemann F, Lange P . Extracorporeal membrane oxygenation as a bridge to cardiac transplantation in children. Artif Organs. 1996; 20(6):728-32. View

15.

Adamson R, Dembitsky W, DAILY P, Copeland J, Smith R . Immediate cardiac allograft failure. ECMO versus total artificial heart support. ASAIO J. 1996; 42(4):314-6. View

16.

Magovern Jr G, Simpson K . Extracorporeal membrane oxygenation for adult cardiac support: the Allegheny experience. Ann Thorac Surg. 1999; 68(2):655-61. DOI: 10.1016/s0003-4975(99)00581-0. View

17.

Morris A, Wallace C, Menlove R, Clemmer T, Orme Jr J, Weaver L . Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994; 149(2 Pt 1):295-305. DOI: 10.1164/ajrccm.149.2.8306022. View

18.

Zapol W, Snider M, Hill J, Fallat R, Bartlett R, EDMUNDS L . Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979; 242(20):2193-6. DOI: 10.1001/jama.242.20.2193. View

19.

. Does extracorporeal membrane oxygenation improve survival in neonates with congenital diaphragmatic hernia? The Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg. 1999; 34(5):720-4; discussion 724-5. DOI: 10.1016/s0022-3468(99)90363-9. View

20.

Koutlas T, Bridges N, Gaynor J, Nicolson S, Steven J, Spray T . Pediatric lung transplantation--are there surgical contraindications?. Transplantation. 1997; 63(2):269-74. DOI: 10.1097/00007890-199701270-00016. View