Histological changes in the hearts of non-survivors of the UK Collaborative Trial of Neonatal ECMO (extra corporeal membrane oxygen)

Aims-To study the cardiac pathology of infants enrolled in the UK collabora tive trial of neonatal ECMO (extra corporeal membrane oxygen) who died foll owing random allocation to a trial arm. Methods-During the trial, 81 infants died. The hearts of 26 babies were rec eived and examined without knowledge of treatment regimen. The control grou p consisted of 14 infants who received conventional treatment. Twelve were allocated to ECMO; seven received this treatment. Results-In the control group, four showed minor histological changes. The o ther hearts were histologically normal. In the group treated with ECMO, fou r had multiple foci of micro-infarction throughout both ventricles and papi llary muscles. There was variable thrombotic vascular occlusion. Three were normal. There was no correlation between cardiac pathology and clinical fe atures. There was a significant difference in the length of survival betwee n the two groups. Conclusions-ECMO treatment seems to be associated with clinically significa nt cardiac pathology The changes observed may reflect the longevity of surv ival in the ECMO group rather than an association with the treatment itself . Nevertheless, the findings have significant implications for those monito ring the development of infants surviving ECMO treatment and suggest that t he monitoring of myocardial function will be crucial.