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Am J Perinatol
DOI: 10.1055/a-2499-4712
Original Article

Outcomes in Neonates Receiving Therapeutic Hypothermia and Extracorporeal Membrane Oxygenation versus Extracorporeal Membrane Oxygenation Alone

Erin Cicalese
1   Division of Neonatology, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone, New York University Grossman School of Medicine, New York, New York
,
Bryn H.S. Seltzer 
1   Division of Neonatology, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone, New York University Grossman School of Medicine, New York, New York
,
Jason C. Fisher
2   Division of Pediatric Surgery, Department of Surgery, Hassenfeld Children's Hospital at NYU Langone, New York University Grossman School of Medicine, New York, New York
,
Sourabh Verma
1   Division of Neonatology, Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone, New York University Grossman School of Medicine, New York, New York
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Abstract

Objective This study aimed to examine survival and outcomes in neonates who received therapeutic hypothermia (TH) for neonatal encephalopathy (NE) and extracorporeal membrane oxygenation (ECMO) versus ECMO alone.

Study Design This is a retrospective review of Extracorporeal Life Support Organization (ELSO) Registry data from 2007 to 2017 for neonates undergoing ECMO and TH for NE (TH/ECMO) or ECMO alone. Primary outcomes were ECMO survival and survival to discharge. Secondary outcomes were complications while on ECMO. Statistical analysis was performed using Fisher's exact and Mann–Whitney U tests. Multivariate regression was performed to identify predictors of ECMO survival.

Results Of 3,672 neonates, 215 (6%) received TH/ECMO, while 3,457 (94%) received ECMO alone. There was no significant difference in ECMO survival (92 vs. 92%, p = 0.70) or survival to discharge (87 vs. 85%, p = 0.43) between groups. TH/ECMO group had higher hemorrhagic (29 vs. 20%, p < 0.01), neurologic (24% vs. 12%, p < 0.01), and metabolic (28 vs. 15%, p < 0.01) complications. Multivariate regression identified higher gestational age, absence of inotropes during ECMO, and lack of neurologic, pulmonary, or hemorrhagic complications as independent predictors of ECMO survival.

Conclusion Neonates undergoing ECMO and TH for NE had survival rates comparable to those receiving ECMO alone. These findings suggest that ECMO can be considered for neonates with NE undergoing TH who meet the criteria for ECMO.

Key Points

  • ECMO survival is comparable between neonates who underwent TH and ECMO versus ECMO alone.

  • Neonates who underwent TH and ECMO had more hemorrhagic, neurologic, and metabolic complications.

  • Offering ECMO to qualifying neonates also undergoing TH is reasonable.

Keywords

ECMO - therapeutic hypothermia - HIE - neonatal encephalopathy

Supplementary Material



Publication History

Received: 16 August 2024

Accepted: 10 December 2024

Accepted Manuscript online:
11 December 2024

Article published online:
30 December 2024

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