The changing demographics of neonatal extracorporeal membrane oxygenation patients reported to the extracorporeal life support organization (ELSO) registry

Background. Extracorporeal membrane oxygenation (ECMO) is an important trea tment tool in the management of near-term and term neonates with severe hyp oxemic respiratory failure. To better understand how health care for patien ts treated with ECMO has changed, we studied the demographic and treatment data reported to the Extracorporeal Life Support Organization (ELSO) regist ry from January 1, 1988, through January 1, 1998. Methods. We used data stored in the ELSO registry and evaluated the changes in demographics, use of alternate therapies before ECMO, severity of illne ss, duration of ECMO therapy, and mortality over a 10-year period. All data on neonates reported between January 1, 1988, and January 1, 1998 were use d. Verification checks were performed on all fields to eliminate nonsense o utliers. We separated the neonates into 2 groups-those with and those witho ut a congenital diaphragmatic hernia (CDH). All analyses were performed on the total group and each subgroup separately. Changes in continuous data we re analyzed by year using analysis of variance. Year differences in categor ical data were evaluated with chi (2) analysis. We also used the linear tre nd test and the Cochran-Armitage trend test to evaluate time-related change s. Results. We reviewed 12 175 neonates. Over the decade, there were no change s in mean gestational age, gender, age at which ECMO was started, pH, or Pa CO2 just before ECMO. The proportion of neonates with CDH increased from 18 % to 26%, while the proportion with respiratory distress syndrome decreased from 15% to 4%. Other diagnostic categories remained constant. The use of surfactant, high-frequency ventilation, and inhaled nitric oxide increased from 0% in 1988 to 36%, 46%, and 24%, respectively, in 1997. The mean peak pressure being used just before ECMO decreased (47 +/- 10 in 1988 to 39 +/- 12 in 1997), and the mean PaO2/FIO2 ratio increased (38 +/- 23 in 1988 to 48 +/- 36 in 1997). The primary mode of ECMO remains venoarterial; however, the use of venovenous ECMO increased from 1% to 32% over the decade. Durat ion of ECMO treatment increased overall, and this trend was seen for patien ts with and without CDH (124 +/- 67 to 141 +/- 104 hours for the non-CDH gr oup, 161 +/- 99 to 238 +/- 141 hours for the CDH group). The number of cent ers reporting neonatal data to the ELSO registry increased from 52 in 1988 to a peak of 100 in 1993. In 1997, 96 centers reported data to ELSO. The av erage number of neonatal patients reported from each site decreased from a peak of 18 in 1991 to 9 in 1997. Mortality increased from 18% to 22%; howev er, when corrected for the relative increase in neonates with CDH, this tre nd disappeared. Diagnoses-specific mortality rates remained constant. The o ccurrence of intracranial hemorrhage and/or infarct also stayed constant at 16%. Conclusions. The population of neonates treated with ECMO in 1997 was very different from patients treated in the 1980s and early 1990s. They were exp osed to an ever-expanding group of new therapies, appeared to be healthier based on indices of gas exchange, and were cared for at centers that report ed fewer cases per year.