THE EFFECT OF ON-SITE EXTRACORPOREAL MEMBRANE-OXYGENATION ON THE THERAPY CHOICE AND OUTCOMES OF NEONATES WITH PERSISTENT PULMONARY-HYPERTENSION

The effect of on-site extracorporeal membrane oxygenation (OS-ECMO) an d selection criteria on the utilization rate of this technology is unk nown. We retrospectively studied 55 neonates who were admitted to Arka nsas Children's Hospital from 1985 to 1993. We compared the ECMO utili zation, mortality, and morbidity rates for outborn neonates with moder ate and severe persistent pulmonary hypertension (PPHN) before and aft er the establishment of an ECMO program with guidelines for its use at our institution. The rate of ECMO use was three times higher and the mortality rate was 13 times lower in the period after OS-ECMO compared with the period when ECMO was available only at other institutions. N o differences were observed in the morbidity rates between the two per iods. Physician decisions to initiate ECMO involved more than guidelin es, since 37% of the increased ECMO use was not associated with use of the guidelines. Possible reasons for noncompliance with the guideline s are discussed. Neonates who had received medical therapy only and wh o had an oxygenation index greater than or equal to 30 and < 40 had no mortality. Our findings suggest that the need for ECMO in this group of neonates is low.