Extracorporeal Membrane Oxygenation As Life Support in Neonatal Respiratory Failure: A Single-Center Cohort Study and a Systematic Review

Overview

Journal Children (Basel)

Specialty Health Services

Date 2025 Jan 8

PMID 39767870

Authors

Raffaele Falsaperla

Rosanna Zanai

Ausilia Desiree Collotta

Vincenzo Sortino

Giovanna Vitaliti

Carla Cimino

Bruna Scalia

Marco Simone Vaccalluzzo

Michela Spatuzza

Grete Francesca Privitera

Alfredo Pulvirenti

Piero Pavone

Martino Ruggieri

Andrea Marino

Salvatore Agati

Affiliations

Soon will be listed here.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is a life support in newborns with severe respiratory failure. Our main objective was to evaluate the mortality of patients and define positive and negative predictive factors of survival.

Methods: We performed a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)-conformed retrospective observational study and a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our data were analyzed using R (v.4.2.1). We performed survival analysis, correlation analysis, and Fisher's exact test. The first endpoint was the mortality rate. The second endpoint was to evaluate all factors associated with survival. The third endpoint was focused on complications of ECMO.

Results: Our study included 8 patients treated in our centers and 45 patients from the literature review. Survival was 79%. Positive predictive factors of survival were a length of ECMO of less than 10 days and male neonates, while prematurity and the presence of 2 complications were negative predictive factors.

Conclusions: ECMO functions as life support, although mortality and morbidity risks are high.

References

Falsaperla R, Vaccalluzzo M, Collotta A, Ruggieri M, Agati S . Extracorporeal Membrane Oxygenation (ECMO) in an Infant with COVID-19: A Case Report with Literature Review. Curr Pediatr Rev. 2023; 20(3):370-374. DOI: 10.2174/1573396320666230417103203. View

Reiterer F, Maurer U, Urlesberger B, Ricabbona M, Zobel G, Muller W . [Successful treatment of therapy refractory shock lung in a newborn infant with congenital varicella using extracorporeal membrane oxygenation]. Klin Padiatr. 1994; 206(2):92-4. DOI: 10.1055/s-2008-1046589. View

Quinones Cardona V, Joshi S, Conway D, Menkiti O . Severe Pulmonary Hemorrhage in a Neonate With Hypoxic Ischemic Encephalopathy and Sepsis Managed on Extracorporeal Membrane Oxygenation. ASAIO J. 2021; 68(6):e106-e109. DOI: 10.1097/MAT.0000000000001520. View

Andrews A, Nixon C, Cilley R, Roloff D, Bartlett R . One- to three-year outcome for 14 neonatal survivors of extracorporeal membrane oxygenation. Pediatrics. 1986; 78(4):692-8. View

Li G, Zhang L, Sun Y, Chen J, Zhou C . Co-initiation of continuous renal replacement therapy, peritoneal dialysis, and extracorporeal membrane oxygenation in neonatal life-threatening hyaline membrane disease: A case report. Medicine (Baltimore). 2019; 98(4):e14194. PMC: 6358340. DOI: 10.1097/MD.0000000000014194. View

Belousova T, Tong Y, Bai Y, Klein K, Tint H, Castillo B . Utilization of therapeutic plasma exchange for hyperbilirubinemia in a premature newborn on extracorporeal membrane oxygenation. J Clin Apher. 2019; 34(5):615-622. DOI: 10.1002/jca.21708. View

Brown G, Moynihan K, Deatrick K, Hoskote A, Sandhu H, Aganga D . Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure. ASAIO J. 2021; 67(5):463-475. DOI: 10.1097/MAT.0000000000001431. View

Schiller R, van den Bosch G, Muetzel R, Smits M, Dudink J, Tibboel D . Neonatal critical illness and development: white matter and hippocampus alterations in school-age neonatal extracorporeal membrane oxygenation survivors. Dev Med Child Neurol. 2016; 59(3):304-310. DOI: 10.1111/dmcn.13309. View

Bartlett R, Andrews A, Toomasian J, Haiduc N, GAZZANIGA A . Extracorporeal membrane oxygenation for newborn respiratory failure: forty-five cases. Surgery. 1982; 92(2):425-33. View

10.

Sainathan S, Heal M, Frantz E, Johnston P, Smith R, Sharma M . Use of VA ECMO and percutaneous palliation of ductal dependent coarctation in a neonate with trisomy 21 and COVID-19 pneumonia. Indian J Thorac Cardiovasc Surg. 2021; 37(6):698-701. PMC: 8149580. DOI: 10.1007/s12055-021-01204-2. View

11.

Wien M, Whitehead M, Bulas D, Ridore M, Melbourne L, Oldenburg G . Patterns of Brain Injury in Newborns Treated with Extracorporeal Membrane Oxygenation. AJNR Am J Neuroradiol. 2017; 38(4):820-826. PMC: 7960244. DOI: 10.3174/ajnr.A5092. View

12.

Dalton H, Reeder R, Garcia-Filion P, Holubkov R, Berg R, Zuppa A . Factors Associated with Bleeding and Thrombosis in Children Receiving Extracorporeal Membrane Oxygenation. Am J Respir Crit Care Med. 2017; 196(6):762-771. PMC: 5620676. DOI: 10.1164/rccm.201609-1945OC. View

13.

Cilley R, Zwischenberger J, Andrews A, Bowerman R, Roloff D, Bartlett R . Intracranial hemorrhage during extracorporeal membrane oxygenation in neonates. Pediatrics. 1986; 78(4):699-704. View

14.

Toledo Del Castillo B, Gordillo I, Rubio Garcia E, Nicole Fernandez Lafever S, Cortes R, Urbano Villaescusa J . Diffuse persistent pulmonary interstitial emphysema secondary to mechanical ventilation in bronchiolitis. BMC Pulm Med. 2016; 16(1):139. PMC: 5094036. DOI: 10.1186/s12890-016-0299-9. View

15.

. The collaborative UK ECMO (Extracorporeal Membrane Oxygenation) trial: follow-up to 1 year of age. Pediatrics. 1998; 101(4):E1. DOI: 10.1542/peds.101.4.e1. View

16.

Croes F, van Nieuwaal N, Van Heijst A, van Enk G . Congenital tracheobiliary fistula. J Pediatr Surg. 2010; 45(4):E9-11. DOI: 10.1016/j.jpedsurg.2010.01.018. View

17.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

18.

Dalton H, Garcia-Filion P, Holubkov R, Moler F, Shanley T, Heidemann S . Association of bleeding and thrombosis with outcome in extracorporeal life support. Pediatr Crit Care Med. 2015; 16(2):167-74. PMC: 4605822. DOI: 10.1097/PCC.0000000000000317. View

19.

Wild K, Rintoul N, Kattan J, Gray B . Extracorporeal Life Support Organization (ELSO): Guidelines for Neonatal Respiratory Failure. ASAIO J. 2020; 66(5):463-470. DOI: 10.1097/MAT.0000000000001153. View

20.

Bahrami K, Van Meurs K . ECMO for neonatal respiratory failure. Semin Perinatol. 2005; 29(1):15-23. DOI: 10.1053/j.semperi.2005.02.004. View