115 - Outcomes in Neonates Receiving Therapeutic Hypothermia and ECMO versus ECMO Alone for Meconium Aspiration Syndrome and/or Persistent Pulmonary Hypertension

Poster Number: 115
Publication Number: 115.2010

Background: Outcomes in neonates receiving extracorporeal membrane oxygenation (ECMO) for meconium aspiration syndrome (MAS) and/or persistent pulmonary hypertension (PPHN) are favorable, however clinicians have traditionally been hesitant to offer ECMO to qualifying neonates who concurrently have hypoxic-ischemic encephalopathy (HIE) and are undergoing therapeutic hypothermia due to concerns for suboptimal outcomes.

Objective: In the absence of robust data regarding ECMO survival and complications for neonates who undergo therapeutic hypothermia and ECMO, we performed a retrospective comparative study examining survival and outcomes in neonates who received ECMO and therapeutic hypothermia versus ECMO alone.

Design/Methods: We reviewed Extracorporeal Life Support Organization (ELSO) Registry data from 2007 to 2017 for neonates with primary diagnoses of MAS and/or PPHN and compared outcomes between patients who received ECMO and therapeutic hypothermia versus ECMO alone. Primary outcomes were ECMO survival and survival to discharge. Secondary outcomes were ECMO complications. Data was analyzed using Fisher's Exact and Mann–Whitney U testing.

Results: There was no significant difference between patients who received therapeutic hypothermia while on ECMO vs ECMO alone in ECMO survival (92% versus 92%, P=0.70) or survival to discharge (87% versus 85%, P=0.43). However, the group who received therapeutic hypothermia did have significantly increased rates of hemorrhagic (29% versus 20%, P< 0.01) and neurologic complications (24% versus 12%, P< 0.01).

Conclusion(s): Although neonates who underwent therapeutic hypothermia while on ECMO were more likely to have hemorrhagic and neurologic complications when compared to neonates who underwent ECMO alone for MAS and/or PPHN, there was no significant difference in survival between groups. These findings suggest that it may be reasonable to offer ECMO for qualifying patients with MAS and/or PPHN who are undergoing therapeutic hypothermia. Future studies should explore risk-benefit assessment tools for determining individual patient level decisions.