Clinical Characteristics and Outcomes for Neonates with Respiratory Failure Referred for Extracorporeal Membrane Oxygenator (ECMO) Support

Abstract

Objective: The aim of this study was to describe the presenting characteristics and outcomes of neonates with respiratory failure referred for extracorporeal membrane oxygenation (ECMO) support, compare those who received ECMO support (ECMO group) to those who did not (non-ECMO group), and evaluate the predictive variables requiring ECMO support. Methods: All neonates (<15 days) with respiratory failure (without congenital diaphragmatic hernia or congenital heart disease) referred to our regional ECMO center from 2014 to 2023 were included in this retrospective study. Patient demographics, birth history, and clinical and outcome variables were analyzed. Oxygenation indices and vasoactive-inotropic scores obtained at PICU arrival and four hours after arrival were compared between the two groups using ROC analysis, with ECMO initiation as an outcome variable. Youden's index was used for optimal threshold values. Chi-square, Mann-Whitney U, and binary logistic regression were used for comparative analyses. Results: Out of the 147 neonates, 96 (65%) required ECMO support. The two groups significantly differed in the prevalence of pulmonary hypertension (pHTN; systemic or suprasystemic pulmonary pressures), lactate level, and oxygenation indices. Mortality was not different between the two groups. Presence of oxygen saturation index (OSI) ≥ 10 had a sensitivity 96.8% in predicting the need for ECMO support. On regression analysis, OSI and pHTN were independent predictors of ECMO support. Conclusions: Oxygenation indices and echo findings predict the need for ECMO support in neonatal hypoxemic respiratory failure. These findings help non-ECMO centers make appropriate and timely transfers of neonates with respiratory failure to ECMO centers.

Keywords: ECMO; neonatal respiratory failure; oxygenation index; persistent pulmonary hypertension of the newborn; vasoactive–inotropic score.

Figure 1

CONSORT diagram. Abbreviations: CDH—congenital diaphragmatic hernia; CHD—congenital heart disease; BRUE—brief resolved unresponsive event; others: hyperammonemia, hypocalcemia, intestinal surgery, non-accidental or accidental trauma, and arteriovenous malformations.

Figure 2

Receiver operating curves for oxygenation indices at time A and time B to predict the need for ECMO support. Area under the ROC curve (95% CI). (A–D): values at PICU arrival; (E–H): values at 4 h after PICU arrival. Abbreviations: SF—SpO₂/FiO₂ ratio; PF—PaO₂/FiO₂ ratio; OSI—oxygen saturation index; OI—oxygenation index.

Figure 2

Receiver operating curves for oxygenation indices at time A and time B to predict the need for ECMO support. Area under the ROC curve (95% CI). (A–D): values at PICU arrival; (E–H): values at 4 h after PICU arrival. Abbreviations: SF—SpO₂/FiO₂ ratio; PF—PaO₂/FiO₂ ratio; OSI—oxygen saturation index; OI—oxygenation index.