To-and-fro veno-venous extracorporeal lung assist for newborns with severe respiratory distress

Extracorporeal CO2 Removal in a Lung Lavage Induced Respiratory Distress Syndrome

Ten pigs with experimental respiratory distress syndrome were treated by extracorporeal CO2 removal (ECCO2-R) combined with low frequency positive pressure ventilation (LPPV). After lung damage had been induced by repeated lung lavages a PEEP trial was conducted in order to find the appropriate PEEP for the damaged lungs. This PEEP was then applied during the ECCO2-R/LPPV period. Blood gas values improved significantly on extracorporeal bypass within a short time (pre-bypass paO2: 54.2 ± 3.7 vs 168.5 ± 31.6 mmHg after 15 min on bypass, p < 0.001) and were kept constant during the next 4 hours. Minute ventilation (MV) was reduced from 4.01 ± 0.31 to 0.74 ± 0.07 l/min (p < 0.0001), FiO2 of the ventilator from 1.0 to 0.46 ± 0.08 (p < 0.0001) whereas FiO2 of the membrane lung (ML) was not changed significantly (FIO2ML 0.59 ± 0.07 vs 0.53 ± 0.06). During controlled mechanical ventilation (CMV), comparable adequate gas exchange was only achieved at a significantly higher mean airway pressure ([Formula: see text] vs 21.2 ± 0.47 cmH20, p < 0.0001). Hemodynamic variables did not change significantly during bypass time. ECCO2-R/LPPV driven by a simple renal perfusion system allows adequate gas exchange in experimental respiratory failure.

Respiratory insufficiency as a cause of neonatal death (with aspects on the potential need for ECMO treatment)

In order to identify children with fatal outcome in a neonatal intensive care unit in which only outborns are admitted, a retrospective study over a 10-year period was undertaken. The study was limited to respiratory disorders. The aim of the study was to identify lethal risk factors and thereby the need for improving therapeutic tools. Diagnoses, perinatal history, ventilator settings, blood gases, medical treatment, X-ray findings, head ultrasounds, echocardiograms, laboratory tests, surgical procedures and autopsy findings were evaluated. Severe respiratory insufficiency requiring mechanical ventilation was found in 777 patients and of these babies, 207 (27%) died while still on the ventilator. Fifty-eight patients were excluded for various reasons and thus 149 patients were included in the study. It is concluded that the mortality rate from respiratory insufficiency in the material studied was consistently high over the 10-year period. New therapeutic modalities, one of which is ECMO, are offered nowadays in clinical practice and may improve mortality and morbidity rates.

Multicenter comparison of conventional venoarterial access versus venovenous double-lumen catheter access in newborn infants undergoing extracorporeal membrane oxygenation

A multicenter trial was designed to compare standard venoarterial (VA) access versus single-catheter, venovenous access using the double-lumen catheter (VV-DLC) for newborns with respiratory failure undergoing extracorporeal membrane oxygenation (ECMO). Twenty-seven ECMO centers participated, each submitting data from the center's most recent VA cases, and data from VV-DLC cases completed upon entering the study. Data from 135 VA ECMO cases and 108 VV-DLC cases were submitted. All diagnoses resulting in neonatal respiratory failure were submitted, including patients with congenital diaphragmatic hernia (24 patients VA bypass, 11 patients VV-DLC bypass). Overall survival in patients undergoing VA bypass was 87%, while survival in patients undergoing VV-DLC bypass was 95%. Eleven patients required conversion from VV-DLC bypass to VA bypass because of insufficient support--10 of these patients survived (91% survival). Average bypass time for newborns undergoing VA bypass was 132 +/- 7.4 hours versus 100 +/- 5.1 hours for those undergoing VV-DLC bypass. Neurologic complications were more common in the VA bypass patients, although the VV patients were more stable. Hemorrhagic, cardiopulmonary, and mechanical complications, other than kinking of the DLC, occurred with approximately equal frequency in each group. In conclusion, in newborns with adequate cardiac function, venovenous ECMO using the DLC can provide the same level of support as conventional VA ECMO, without ligation of the carotid artery.