Extracorporeal membrane oxygenation for newborn respiratory failure.

Jugular vein-carotid artery extracorporeal membrane oxygenation (ECMO) was utilized in 22 newborns (16 male and 6 female) 1 to 12 days old with respiratory failure due to meconium aspiration (12 patients), diaphragmatic hernia (4), persistent fetal circulation (3), hyaline membrane disease (2), and Rh incompatibility (1). Prior to ECMO, all patients had alveolar-arterial O2 pressure gradients greater than 580 mm Hg (predicted mortality greater than 90%), weighed more than 1,800 gm, had a gestation period of longer than 35 weeks, and had no cerebral hemorrhage. The duration of ECMO was 41 to 310 hours (mean, 134.5 hours). Nineteen (86%) of the 22 patients survived ECMO. Death was caused by lung disease (2) and cerebral hemorrhage (1). Four other patients died 6 to 40 days after ECMO of pulmonary hypoplasia (1), pneumonia (1), cerebral edema (1), and hepatorenal failure (1). Complications during ECMO were few and easily managed. Fifteen infants (68%) are alive 1 to 18 months after ECMO. Three have neurological deficit (2 severe, 1 mild). Bayley Developmental Examinations in 4 survivors now more than 12 months old are normal. Extracorporeal membrane oxygenation is an aggressive but effective technique of life support in newborns refractory to conventional respiratory management. Potential complications of ECMO mandate strict aseptic technique, constant monitoring, and multidisciplinary patient management.