The effect of on-site extracorporeal membrane oxygenation on the therapy choice and outcomes of neonates with persistent pulmonary hypertension.

Abstract

The effect of on-site extracorporeal membrane oxygenation (OS-ECMO) and selection criteria on the utilization rate of this technology is unknown. We retrospectively studied 55 neonates who were admitted to Arkansas Children's Hospital from 1985 to 1993. We compared the ECMO utilization, mortality, and morbidity rates for outborn neonates with moderate and severe persistent pulmonary hypertension (PPHN) before and after the establishment of an ECMO program with guidelines for its use at our institution. The rate of ECMO use was three times higher and the mortality rate was 13 times lower in the period after OS-ECMO compared with the period when ECMO was available only at other institutions. No differences were observed in the morbidity rates between the two periods. Physician decisions to initiate ECMO involved more than guidelines, since 37% of the increased ECMO use was not associated with use of the guidelines. Possible reasons for noncompliance with the guidelines are discussed. Neonates who had received medical therapy only and who had an oxygenation index > or = 30 and < 40 had no mortality. Our findings suggest that the need for ECMO in this group of neonates is low.