This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Robert P. Foglia, MD; H. Scott Bjerke, MD; Robert E. Kelly, Jr, MD; J. Duncan Phillips, MD; Larry Barcliff, RRT; Eric W. Fonkalsrud, MD

Arch Surg. 1990;125(10):1286-1292.

Abstract
• We report 18 consecutive neonates with severe respiratory failure due to pulmonary hypertension treated with extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation was begun at 52 ± 36 hours of age with an arterial partial pressure of oxygen (Po₂) of 36±14 mm Hg despite maximal pharmacologic and ventilator support (inspired fraction of oxygen [Fio₂], 0.99±0.03; respiratory rate, 98±31/min; and positive inspiratory pressure, 54±11 cm of water). With initial flows of 130±17 mL/kg per minute, ventilator settings were reduced to the following: Fio₂, 0.30; respiratory rates, 15/min; and positive inspiratory pressure, 24 cm of water. Support using extracorporeal membrane oxygenation was gradually reduced to 22% of initial flows and arterial blood samples showed pH 7.48 ±.05, Po₂ of 106 ± 27 mm Hg, and Pco₂ of 36 ± 5 mm Hg just prior to decannulation. After 107±45 hours, extracorporeal membrane oxygenation was stopped and infants were extubated 61 ±53 hours (median, 46 hours) afterward. There was one death (94.4% survival rate); all survivors were discharged and underwent a follow-up examination at 1 to 27 months of age. Complications included two intracranial hemorrhages (one death and one asymptomatic), one patent ductus arteriosis requiring ligation on extracorporeal membrane oxygenation, and chronic lung disease in one patient. In selected neonates, extracorporeal membrane oxygenation allows for resolution of pulmonary hypertension, results in improved survival, and is associated with a low incidence of chronic lung disease. Extracorporeal membrane oxygenation should be considered in the treatment of severe respiratory failure.

(Arch Surg. 1990;125:1286-1292)

Author Affiliations
From the Division of Pediatric Surgery, Department of Surgery, UCLA Medical Center.

Footnotes
Accepted for publication June 9, 1990.

Read before the 61st Annual Meeting of the Pacific Coast Surgical Association, Laguna Niguel, Calif, February 19, 1990.

Reprint requests to Division of Pediatric Surgery, St Louis Children's Hospital, 400 S Kingshighway Blvd, St Louis, MO 63110 (Dr Foglia).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Surgery
Organ and Henderson
JAMA 1991;265:3172-3175.
ABSTRACT