Abstract Objective To study the clinical value of extracorporeal membrane oxygenation (ECMO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN). Methods A retrospective analysis was performed on the medical data of 11 neonates with PPHN who were treated with ECMO in the Neonatal Intensive Care Unit of Zhongshan People's Hospital from January 2015 to December 2021, involving the neonates' general information, clinical diagnosis, laboratory results, duration of ECMO treatment, complications during ECMO treatment, length of hospital stay, and outcome. Results Of the 11 neonates, 10 (91%) had successful weaning from ECMO, and 8 (73%) survived. For the 11 neonates, the mean duration of ECMO treatment was (81±50) hours (range: 26 to 185 hours), the mean duration of ventilator use was (198±105) hours (range: 57 to 392 hours), and the mean length of hospital stay was (22±15) days (range: 2 to 49 days). The oxygenation index and blood lactate level were significantly improved after 24 hours of ECMO treatment among the 11 neonates (P<0.05). Ten neonates had significantly reduced pulmonary artery pressure after 24 hours of ECMO treatment (P<0.05). One neonate had a progressive increase in the pulmonary artery pressure during EMCO treatment, succumbing to death. This neonate was diagnosed with alveolar capillary dysplasia based on the histopathological findings of the lung tissue and whole-exome sequencing results. Among the 11 children, 5 had intracranial hemorrhage, 1 had disseminated intravascular coagulation, 1 had gastric hemorrhage, 2 had pulmonary hemorrhage, 1 had renal insufficiency, and 3 had bleeding at the puncture site during ECMO treatment. Conclusions ECMO is effective for the treatment of PPHN, however, the high incidence of complications of ECMO treatment suggests that it is important to carefully assess the indications and timing of ECMO treatment and improve the management of ECMO, which can improve the weaning rate and survival rate.
Corresponding Authors:
Yang X-F，E-mail：yxf8787@163.com
E-mail: yxf8787@163.com
Cite this article:
CHEN Yu-Lan,YANG Xiu-Fang,CHEN Jian et al. Application of extracorporeal membrane oxygenation in the treatment of persistent pulmonary hypertension of the newborn[J]. CJCP, 2022, 24(7): 786-791.
CHEN Yu-Lan,YANG Xiu-Fang,CHEN Jian et al. Application of extracorporeal membrane oxygenation in the treatment of persistent pulmonary hypertension of the newborn[J]. CJCP, 2022, 24(7): 786-791.
Donald DE, Harshbarger HG, Kirklin JW. Studies in extracorporeal circulation. II. A method for the recovery and use of blood from the open heart during extracorporeal circulation in man[J]. Ann Surg, 1956, 144(2): 223-227. PMID: 13355195.PMCID: PMC1465317. DOI: 10.1097/00000658-195608000-00013.
2 Extracorporeal Life Support Organization. ELSO guidelines for cardiopulmonary extracorporeal life support[EB/OL]. (2017-08)[2022-01]. https://www.elso.org/Resources/Guidelines.aspx.
Bartlett RH, Gazzaniga AB, Fong SW, et al. Extracorporeal membrane oxygenator support for cardiopulmonary failure. Experience in 28 cases[J]. J Thorac Cardiovasc Surg, 1977, 73(3): 375-386. PMID: 839827.
4 Extracorporeal Life Support Organization. Extracorporeal Life Support Organization registry report: international summary[EB/OL]. (2022-04)[2022-06]. https://www.elso.org/Registry/InternationalSummaryandReports/InternationalSummary.aspx.
Wild KT, Rintoul N, Kattan J, et al. Extracorporeal life support organization (ELSO): guidelines for neonatal respiratory failure[J]. ASAIO J, 2020, 66(5): 463-470. PMID: 32282347. DOI: 10.1097/MAT.0000000000001153.
8 Extracorporeal Life Support Organization. Guidelines for pediatric cardiac failure[EB/OL]. (2021-05)[2022-01]. https://www.pediatriccardiaclearningcenter.org/guidelines/cardiac/ELSO%202018%20Guidelines-%20Pediatric%20Cardiac%20Failure.pdf.
Sen P, Yang Y, Navarro C, et al. Novel FOXF1 mutations in sporadic and familial cases of alveolar capillary dysplasia with misaligned pulmonary veins imply a role for its DNA binding domain[J]. Hum Mutat, 2013, 34(6): 801-811. PMID: 23505205. PMCID: PMC3663886. DOI: 10.1002/humu.22313.
Lazar DA, Cass DL, Olutoye OO, et al. The use of ECMO for persistent pulmonary hypertension of the newborn: a decade of experience[J]. J Surg Res, 2012, 177(2): 263-267. PMID: 22901797. DOI: 10.1016/j.jss.2012.07.058.
Fleming GM, Sahay R, Zappitelli M, et al. The incidence of acute kidney injury and its effect on neonatal and pediatric extracorporeal membrane oxygenation outcomes: a multicenter report from the kidney intervention during extracorporeal membrane oxygenation study group[J]. Pediatr Crit Care Med, 2016, 17(12): 1157-1169. PMID: 27755398.PMCID: PMC5138084. DOI: 10.1097/PCC.0000000000000970.
Thomas J, Kostousov V, Teruya J. Bleeding and thrombotic complications in the use of extracorporeal membrane oxygenation[J]. Semin ThrombHemost, 2018, 44(1): 20-29. PMID: 28898902. DOI: 10.1055/s-0037-1606179.
