ECMO and “new” therapies

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Extracorporeal membrane oxygenation (ECMO) was initially evaluated for pulmonary hypertension in newborns that primarily had meconium aspiration or idiopathic pulmonary hypertension. These diagnoses are now less frequent, and other diverse causes of severe cardio-respiratory failure are now treated with ECMO. As diagnoses of patients receiving ECMO have changed, so have other treatments used to avoid ECMO changed. It is now routine to use surfactant, nitric oxide, and high frequency oscillation to try to stabilize respiratory function to avoid ECMO. The lingering concern has been that these delaying tactics may compromise those infants who eventually require ECMO.

As a commendable example of prospectively collecting information about a relatively infrequent and risky therapy, clinicians providing ECMO have voluntarily contributed data on all ECMO patients to the Extracorporeal Life Support Organization (ELSO). Fliman et al report on the effect of therapies prior to ECMO for 7017 neonates with data from the ELSO database collected between 1996 and 2003.

When adjusted for clinical variables, surfactant use prior to ECMO was associated with decreased death, and nitric oxide or high frequency ventilation prior to ECMO did not change death rates. None of the therapies prolonged the time on ECMO or the total period of mechanical ventilation. These important observations, although not from a randomized study, illustrate the great value of a registry for a therapy.