PULMONARY HEMORRHAGE - A NOVEL COMPLICATION AFTER EXTRACORPOREAL LIFE-SUPPORT

Pulmonary hemorrhage (PH) occurs infrequently as a complication in neo nates with respiratory failure. Major PH has been observed at the auth ors' institution in several neonates after ''successful'' completion o f extracorporeal life support(ECLS)therapy. The authors sought to dete rmine the incidence of PH and the risk factors associated with this un ique and newly described morbidity after ECLS. The hospital records of all patients who had PH after ECLS were reviewed. The control patient s were the first three infants who underwent ECLS just before each PH case. PH was defined as the occurrence of bloody tracheal secretions a ssociated with a deterioration in pulmonary status, Demographics, vent ilator/ECLS parameters, fluid management, coagulation, and laboratory studies were evaluated in the pre-ECLS, during ECLS, and in the post-E CLS period. From 1985 to 1993, 13 (6%) of 214 neonates suffered major PH, at a mean time of 43.2 +/- 9.2 hours after the ECLS course. The ov erall mortality rate for children with PH was 38%, compared with 5% am ong the control patients. In the pre-ECLS phase, patients with PH requ ired more fluid (153.6 +/- 20.2 mL/kg/d v 106.8 +/- 10.2 mL/kg/d) and were acidemic for a longer period (2.3 +/- 1.2 hours v 0.6 +/- 0.2 hou rs; pH < 7.25). No differences were noted in AaDo(2) or oxygenation in dex criteria. During ECLS; inotropes were required more often (23% v 0 %; P < .01) because hypotension was more common (77% v 33%; P < .05). Activated clotting times (ACT) and heparin requirements were equivalen t for the two groups. After ECLS the patients with PH required longer ventilatory assistance (184.9 +/- 48.2 hours v 83.4 +/- 16.7 hours) an d supplemental oxygen (24.3 +/- 3.0 days v 17.2 +/- 1.9 days). No coag ulation abnormalities were identified at the time of PH. Higher SGPT ( 185.4 +/- 146.4 U/L v 22.6 +/- 3.5 U/L; P < .05) and BUN (69.3 +/- 7.5 mg/dL v 47.2 +/- 5.9 mg/dL; P < .05) also were noted for the patients with PH. PH represents an important and novel morbidity in neonates a fter ECLS. Prolonged acidosis, a high fluid requirement before ECLS, t he need for blood pressure support during ECLS, and evidence of renal and/ or hepatic dysfunction serve to identify patients who have a high risk for the development of this complication. Copyright (C) 1996 by W.B. Saunders Company