HIGH-FREQUENCY OSCILLATORY VENTILATION AND NITRIC-OXIDE - ALTERNATIVEOR COMPLEMENTARY TO ECMO

One hundred and seventy-seven term or near-term neonates were referred to an ECMO center for severe PPHN-associated diseases. In 2 time peri ods from 1987 to 1991 and from 1992 to April 1995 alternative treatmen t modes were fried in an attempt to obviate ECMO. During the first tim e period patients underwent trial high-frequency oscillatory ventilati on before ECMO. In the second time period patients first received inha led NO followed by HFOV in a non-responders. If this also failed HFOV was combined with INO. In both time periods about 40% of the patients were spared ECMO treatment by these alternative treatment modalities. INO only benefited 15% of the ECMO candidates who apparently had fared just as well on HFOV alone in the preceding time period. While patien ts who were improved by INO were spared HFOV with its potential severe complications, i.e. air leaks and cardiocirculatory instability, more extended long-term studies will have to show which of these 2 treatme nt modalities (INO or HFOV) should be given first priority in an attem pt to avoid ECMO in neonates with severe respiratory failure.