ECHOCARDIOGRAPHIC PREDICTION OF NEONATAL ECMO OUTCOME

Cardiopulmonary physiology was assessed by Doppler echocardiography in neonates undergoing pre-ECMO evaluation for meconium aspiration syndr ome, congenital diaphragmatic hernia, persistent fetal circulation, an d sepsis, from March 1987 through July 1992 (n = 136). Percent surviva l by diagnosis was: meconium aspiration syndrome, 86%; persistent feta l circulation, 68%; congenital diaphragmatic hernia, 63%; sepsis, 33%. Survival odds by diagnosis predicted a better outcome for meconium as piration syndrome than for congenital diaphragmatic hernia and sepsis, and a better outcome for persistent fetal circulation than for sepsis . Percent survival for right-to-left patent ductus arteriosus flow (PD A) was 56%; other patent ductus arteriosus flow was 84%. In multivaria te analysis, percent survival in congenital diaphragmatic hernia and p ersistent fetal circulation patients with right-to-left PDA flow sugge sted a worse outcome (% survival right-to-left vs other: congenital di aphragmatic hernia, 13% vs 70%; persistent fetal circulation, 25% vs 8 5%), whereas percent survival did not appear to suggest the same in me conium aspiration syndrome or sepsis patients. Similar analysis in non -ECMO patients suggested a worse outcome with right-to-left PDA flow i n patients with meconium aspiration syndrome and congenital diaphragma tic hernia. Right-to-left PDA flow, sepsis, and congenital diaphragmat ic hernia were associated with a poorer ECMO outcome. Initial assessme nt of PDA flow helps predict ECMO outcome.