PURPOSE: Controversy exists regarding the criteria for placement of infants on extracorporeal membrane oxygenation (ECMO) at low birth weights. The authors hypothesized that ECMO is effective and safe in babies under 2 kg and sought to examine outcome and survival rate in these infants. METHODS: All patients less than 30 days old in the Extracorporeal Life Support Organization (ELSO) registry (n = 14,305) were divided into those less than 2 kg (n = 663) and more than 2 kg (n = 13,642). Multiple regression analysis determined factors that predicted survival rate and the lowest safe weight for ECMO. RESULTS: Overall survival rate was 76% and was lower in infants less than 2 kg (> or =2 kg, 77% v <2 kg, 53%, P <.0001). Survival rate was significantly lower for patients with diaphragmatic hernia (CDH), bleeding, and intracranial hemorrhage (ICH) by regression. The incidence of ICH in babies less than 2.0 kg was 6% versus 4% in those more than 2.0 kg (P <.05). Regression analysis determined that the lowest weight at which a survival rate of 40% could be achieved was 1.6 kg. CONCLUSIONS: Cannulation for ECMO may be safe and effective in babies under 2.0 kg and potentially as low as 1.6 kg. Judicious anticoagulation might limit bleeding, which occurred in a minority of these patients.
PURPOSE: Controversy exists regarding the criteria for placement of infants on extracorporeal membrane oxygenation (ECMO) at low birth weights. The authors hypothesized that ECMO is effective and safe in babies under 2 kg and sought to examine outcome and survival rate in these infants. METHODS: All patients less than 30 days old in the Extracorporeal Life Support Organization (ELSO) registry (n = 14,305) were divided into those less than 2 kg (n = 663) and more than 2 kg (n = 13,642). Multiple regression analysis determined factors that predicted survival rate and the lowest safe weight for ECMO. RESULTS: Overall survival rate was 76% and was lower in infants less than 2 kg (> or =2 kg, 77% v <2 kg, 53%, P <.0001). Survival rate was significantly lower for patients with diaphragmatic hernia (CDH), bleeding, and intracranial hemorrhage (ICH) by regression. The incidence of ICH in babies less than 2.0 kg was 6% versus 4% in those more than 2.0 kg (P <.05). Regression analysis determined that the lowest weight at which a survival rate of 40% could be achieved was 1.6 kg. CONCLUSIONS: Cannulation for ECMO may be safe and effective in babies under 2.0 kg and potentially as low as 1.6 kg. Judicious anticoagulation might limit bleeding, which occurred in a minority of these patients.
Authors: Patrick T Delaplain; Lishi Zhang; Yanjun Chen; Danh V Nguyen; Matteo Di Nardo; John Patrick Cleary; Peter T Yu; Yigit S Guner Journal: J Pediatr Surg Date: 2017-09-02 Impact factor: 2.545
Authors: Angelo Polito; Cindy S Barrett; David Wypij; Peter T Rycus; Roberta Netto; Paola E Cogo; Ravi R Thiagarajan Journal: Intensive Care Med Date: 2013-06-08 Impact factor: 17.440
Authors: Ryan P Barbaro; Robert H Bartlett; Rachel L Chapman; Matthew L Paden; Lloyd A Roberts; Achamyeleh Gebremariam; Gail M Annich; Matthew M Davis Journal: J Pediatr Date: 2016-03-19 Impact factor: 4.406