Prashant Agarwal1, Girija Natarajan2, Kevin Sullivan3, Rakesh Rao4, Natalie Rintoul5, Isabella Zaniletti6, Sarah Keene7, Ulrike Mietzsch8, An N Massaro9, Zeenia Billimoria8, Daniel Dirnberger10, Shannon Hamrick7, Ruth B Seabrook11, Mark F Weems12, John P Cleary13, Brian W Gray14, Robert DiGeronimo8. 1. Department of Pediatrics, Children's Hospital of Michigan/Central Michigan University, Detroit, MI, USA. pagarwal@dmc.org. 2. Department of Pediatrics, Children's Hospital of Michigan/Central Michigan University, Detroit, MI, USA. 3. Department of Pediatrics, AI duPont Hospital for Children/Thomas Jefferson University, Wilmington, DE, USA. 4. Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA. 5. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 6. Children's Hospital Association, Lenexa, KS, USA. 7. Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA. 8. Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, WA, USA. 9. Department of Pediatrics, The George Washington University School of Medicine and Children's National Hospital, Washington DC, DC, USA. 10. Department of Pediatrics, AI duPont Hospital for Children, Wilmington, DE, USA. 11. Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA. 12. Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA. 13. Department of Pediatrics, Children's Hospital of Orange County, Orange, CA, USA. 14. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Abstract
OBJECTIVE: Our hypothesis was that among infants with hypoxic-ischemic encephalopathy (HIE), venoarterial (VA), compared to venovenous (VV), extracorporeal membrane oxygenation (ECMO) is associated with an increased risk of mortality or intracranial hemorrhage (ICH). DESIGN/ METHODS: Retrospective cohort analysis of infants in the Children's Hospitals Neonatal Database from 2010 to 2016 with moderate or severe HIE, gestational age ≥36 weeks, and ECMO initiation <7 days of age. The primary outcome was mortality or ICH. RESULTS: Severe HIE was more common in the VA ECMO group (n = 57), compared to the VV ECMO group (n = 53) (47.4% vs. 26.4%, P = 0.02). VA ECMO was associated with a significantly higher risk of death or ICH [57.9% vs. 34.0%, aOR 2.39 (1.08-5.28)] and mortality [31.6% vs. 11.3%, aOR 3.06 (1.08-8.68)], after adjusting for HIE severity. CONCLUSIONS: In HIE, VA ECMO was associated with a higher incidence of mortality or ICH. VV ECMO may be beneficial in this population.
OBJECTIVE: Our hypothesis was that among infants with hypoxic-ischemic encephalopathy (HIE), venoarterial (VA), compared to venovenous (VV), extracorporeal membrane oxygenation (ECMO) is associated with an increased risk of mortality or intracranial hemorrhage (ICH). DESIGN/ METHODS: Retrospective cohort analysis of infants in the Children's Hospitals Neonatal Database from 2010 to 2016 with moderate or severe HIE, gestational age ≥36 weeks, and ECMO initiation <7 days of age. The primary outcome was mortality or ICH. RESULTS: Severe HIE was more common in the VA ECMO group (n = 57), compared to the VV ECMO group (n = 53) (47.4% vs. 26.4%, P = 0.02). VA ECMO was associated with a significantly higher risk of death or ICH [57.9% vs. 34.0%, aOR 2.39 (1.08-5.28)] and mortality [31.6% vs. 11.3%, aOR 3.06 (1.08-8.68)], after adjusting for HIE severity. CONCLUSIONS: In HIE, VA ECMO was associated with a higher incidence of mortality or ICH. VV ECMO may be beneficial in this population.
Authors: Seetha Shankaran; Patrick D Barnes; Susan R Hintz; Abbott R Laptook; Kristin M Zaterka-Baxter; Scott A McDonald; Richard A Ehrenkranz; Michele C Walsh; Jon E Tyson; Edward F Donovan; Ronald N Goldberg; Rebecca Bara; Abhik Das; Neil N Finer; Pablo J Sanchez; Brenda B Poindexter; Krisa P Van Meurs; Waldemar A Carlo; Barbara J Stoll; Shahnaz Duara; Ronnie Guillet; Rosemary D Higgins Journal: Arch Dis Child Fetal Neonatal Ed Date: 2012-11 Impact factor: 5.747