EXTRACORPOREAL LIFE-SUPPORT FOR NEONATAL RESPIRATORY-FAILURE - A 20-YEAR EXPERIENCE

Objective The authors reviewed their experience with extracorporeal li fe support (ECLS) in neonatal respiratory failure; they define changes in patient population, technique, and outcomes. Summary Background Da ta Extracorporeal life support has progressed from laboratory research to initial clinical trials in 1972, Following a decade of clinical re search, ECLS is now standard treatment for neonaial respiratory failur e refractory to conventional pulmonary support techniques. Our group h as the longest and largest experience with this technique. Methods Bet ween 1973 and 1993, 460 neonates with severe respiratory failure were treated using ECLS. The records of ail patients were reviewed. Results Overall survival was 87%. Primary diagnoses were meconium aspiration syndrome (MAS; 169 cases [96% survival]), respiratory distress syndrom e/hyaline membrane disease (91 cases [88% survival]), persistent pulmo nary hypertension of the newborn (37 cases [92%]), pneumonia/sepsis (7 5 cases [84% survival]), congenital diaphragmatic hernia (CDH; 67 case s [67% survival]), and other diagnoses (21 cases [71% survival]). Comm on mechanical complications included dots in the circuit (136; 85% sur vival); air in the circuit (67; 82% survival); cannula problems (65; 8 3% survival) and oxygenator failure (34; 65% survival). Patient-relate d complications included intracranial infarct or bleed (54 cases; 61% survival), major bleeding (48 cases; 81% survival), seizures (88 cases ; 76% survival), metabolic abnormalities(158 cases; 71% survival) and infection (21 cases; 48% survival). Since 1989, treatment groups have been expanded to include premature infants (13 cases; 62% survival), i nfants with grade I intracranial hemorrhage (28 cases; 54% survival) a nd ''non-honeymoon'' CDH patients (15 cases; 27% survival). Since 1990 , single-catheter venovenous access has been used in 131 patients (97% survival) and currently is the preferred mode of access, Follow-up ra nges from 1 to 19 years; 80% of patients are growing and developing no rmally. Conclusions Extracorporeal life support has become standard tr eatment for severe neonatal respiratory failure in our center (460 cas es; 87% survival), and worldwide (8913 cases; 81% survival). The avail ability of ECLS makes the evaluation of other innovative methods of tr eatment, such as late elective repair of diaphragmatic hernia and new pulmonary vasodilators, possible. The application of ECLS is now being extended to premature and low-birth weight infants as well as older c hildren and adults.