EXTRACORPOREAL MEMBRANE-OXYGENATION WITH VENOVENOUS BYPASS AND APNEICOXYGENATION FOR TREATMENT OF SEVERE NEONATAL RESPIRATORY-FAILURE

Seven newborn infants with life-threatening respiratory failure were t reated with veno-venous (V-V) extracorporeal lung support and apneic o xygenation after maximal ventilatory and pharmacological treatment fai led. Diagnosis were meconium aspiration syndrome in 3 cases, respirato ry distress syndrome in 2, sepsis in 1, congenital diaphragmatic herni a in 1. Before ECMO 6 infants received tolazoline, 4 surfactant, 3 hig h frequency ventilation, 1 prostaglandin E, 1 epoprostenol, 2 nitric o xide. Newborns were highly hypoxemic at admission and all but one unde rwent rescue cannulation. V-V bypass was performed with a single lumen single cannula and tidal flow was generated by an alternating clamp u sing a non-occlusive roller pump. The mean duration of bypass was 162. 4+/-162.3 hours and infants were extubated 94.5+/-74.8 hours after dec annulation. Five newborns survived and two died. Growth and neurologic development of the older children is normal. The extracorporeal lung support with V-V bypass associated with apneic oxygenation was effecti ve in reversing severe neonatal respiratory failure unresponsive to ma ximal ventilatory and pharmacological support. An early referral, prio r to meeting ECMO criteria, is important in order to avoid hypoxic com plications preceding ECMO.