Abstract
Extracorporeal membrane oxygenation (ECMO) was used in the treatment of 120 newborn infants with respiratory failure in three phase: Phase I (50 moribund patients to determine safety, efficacy, and risks); Phase 11 (30 high risk patients to compare ECMO to conventional ventilation); and Phase III (40 moderate to high risk patients, the current protocol). Ninety one patients survived including 54% in Phase I, 90% in Phase II, 92% in Phase III. The major complication was intracranial bleeding which occurred in 89% of premature infants (<35 weeks) and 15% of full-term infants. Best survival results were in persistent fetal circulation (14, 14 survived), followed by congenital diaphramatic hernia (13, 10 survived), meconium aspiration (51, 44 survived), respiratory distress syndrome (27, 14 survived), and sepsis (12, 7 survived). There were seven late deaths; in follow up 63% are normal or near normal, 17% had moderate to severe CNS dysfunction and 8% had severe pulmonary dysfunction. ECMO is now used in several neonatal centers as the treatment of choice for full-term infants with respiratory failure which is unresponsive to conventional management. The success of this technique establishes prolonged extracorporeal circulation as a definitive means of treatment in reversible vital organ failure.
