ECMO: regional evaluation of need and applicability of selection criteria
C. H. Cole, E. Jillson and D. Kessler
Department of Pediatrics, University of Vermont, Medical Center Hospital, Vermont 05405.
The need and indications for neonatal extracorporeal membrane oxygenation
(ECMO) are controversial. The need for ECMO in two New England states was
studied through a review of deaths due to respiratory failure in near- and
full-term infants. Vermont averaged 2.4 and Maine averaged 7.4 deaths
annually. Neither state demonstrated sufficient respiratory deaths to
establish ECMO capability. The number of "potential" ECMO candidates, based
on published selection criteria, was studied, and the applicability of
criteria was evaluated. A two-year review revealed 16 potential candidates
from Maine and 19 from Vermont. No criterion accurately identified
nonsurvivors of conventional ventilatory therapy. Only one criterion in one
institution demonstrated an association with chronic lung disease. The data
demonstrated that published ECMO selection criteria were not applicable in
different populations.
