Changing populations being treated with ECMO in the neonatal period – who are the others?. Issue 6 (December 2022)

• Record Type: Journal Article
• Authors: Rose, Allison T.; Keene, Sarah
• Is Part Of: Seminars in fetal & neonatal medicine. Volume 27:Issue 6(2022)
• Publication Date: 2022-12
• Subjects: Extracorporeal membrane oxygenation -- Respiratory -- Neonate -- Diagnosis -- Epidemiology; Neonatology -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.9201
• DOI: 10.1016/j.siny.2022.101402
• Languages: English
• ISSNs: 1744-165X

Abstract

Abstract: Extracorporeal life support via extracorporeal membrane oxygenation (ECMO) has served the sickest of neonates for almost 50 years. Naturally, the characteristics of neonates receiving ECMO have changed. Advances in care have averted the need for ECMO for some, while complex cases with uncertain outcomes, previously not eligible for ECMO, are now considered. Characterizing the disease states and outcomes for neonates on ECMO is challenging as many infants do not fall into classic categories, i.e. meconium aspiration syndrome (MAS), respiratory distress syndrome (RDS), or congenital diaphragmatic hernia (CDH). Since 2017, over one third of neonatal respiratory ECMO runs reported to the Extracorporeal Life Support Organization Registry are grouped as Other, a catch-all that encompasses those with a diagnosis not included in the classic categories. This review summarizes the historical neonatal ECMO population, reviews advances in therapy and technology impacting neonatal care, and addresses the unknowns in the ever-growing category of Other. Highlights: The neonatal population treated with ECMO has changed and broadened over time Less information is available about these newer populations, but many seem to have satisfactory outcomes ECMO therapy is potentially lifesaving, but also highly invasive and the risk-benefit ratio much be evaluated for each individual patient with the available evidence The role of ECMO in multi-factorial respiratory failure with a better understanding of who is being treated with ECMO The impact of genetic testing on ECMO consideration and utilization Long term outcomes for neonates with atypical causes of respiratory failure and ECMO use.