Echocardiographic prediction of neonatal ECMO outcome

• Published in: Pediatric cardiology 1997-07, Vol.18 (4), p.270-275
• Main Authors: Gotteiner, N L, Harper, W R, Gidding, S S, Berdusis, K, Wiley, A M, Reynolds, M, Benson, Jr, D W
• Format: Article
• Language: English
• Subjects: Ductus Arteriosus, Patent - diagnostic imaging; Echocardiography, Doppler; Extracorporeal Membrane Oxygenation; Heart Defects, Congenital - diagnostic imaging; Heart Septal Defects, Atrial - diagnostic imaging; Hernia, Diaphragmatic - diagnostic imaging; Hernia, Diaphragmatic - therapy; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Meconium Aspiration Syndrome - diagnostic imaging; Meconium Aspiration Syndrome - therapy; Persistent Fetal Circulation Syndrome - diagnostic imaging; Persistent Fetal Circulation Syndrome - therapy; Predictive Value of Tests; Sepsis - diagnostic imaging; Sepsis - therapy; Treatment Outcome
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s002469900173

Cardiopulmonary physiology was assessed by Doppler echocardiography in neonates undergoing pre-ECMO evaluation for meconium aspiration syndrome, congenital diaphragmatic hernia, persistent fetal circulation, and sepsis, from March 1987 through July 1992 (n = 136). Percent survival by diagnosis was: meconium aspiration syndrome, 86%; persistent fetal circulation, 68%; congenital diaphragmatic hernia, 63%; sepsis, 33%. Survival odds by diagnosis predicted a better outcome for meconium aspiration syndrome than for congenital diaphragmatic hernia and sepsis, and a better outcome for persistent fetal circulation than for sepsis. Percent survival for right-to-left patent ductus arteriosus flow (PDA) was 56%; other patent ductus arteriosus flow was 84%. In multivariate analysis, percent survival in congenital diaphragmatic hernia and persistent fetal circulation patients with right-to-left PDA flow suggested a worse outcome (% survival right-to-left vs other: congenital diaphragmatic hernia, 13% vs 70%; persistent fetal circulation, 25% vs 85%), whereas percent survival did not appear to suggest the same in meconium aspiration syndrome or sepsis patients. Similar analysis in non-ECMO patients suggested a worse outcome with right-to-left PDA flow in patients with meconium aspiration syndrome and congenital diaphragmatic hernia. Right-to-left PDA flow, sepsis, and congenital diaphragmatic hernia were associated with a poorer ECMO outcome. Initial assessment of PDA flow helps predict ECMO outcome.