A second course of extracorporeal membrane oxygenation in the neonate--is there a benefit?

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is an effective therapy for infants with severe respiratory failure and pulmonary hypertension. In most patients once the disease reverses, it does not recur. However, in some patients pulmonary hypertension recurs and these infants meet criteria for a second course of ECMO. We evaluated the survival rate and feasibility of a second course of ECMO in neonates.

METHODS: A questionnaire was sent to all active ECMO programs that requested data about patients who received two courses of ECMO. A retrospective review of the results from responding centers was performed to evaluate indications and outcome.

RESULTS: The overall survival rate for the 58 neonates was 40%. Thirty-four patients with congenital diaphragmatic hernia had a survival rate of 47%, and 12 infants with primary persistent pulmonary hypertension had an 8% survival rate (p < 0.05). Most patients were treated with venoarterial ECMO for both courses.

CONCLUSIONS: There is a reasonable survival rate for selected neonates who are treated with a second course of ECMO. Infants with primary persistent pulmonary hypertension should be carefully examined before institution of a second course of ECMO.