Application of in Vitro Membrane Pulmonary Oxygenation Technology (ECMO) in Neonatal Respiratory Failure

Research Article

Austin J Obstet Gynecol. 2023; 10(2): 1220.

Application of in Vitro Membrane Pulmonary Oxygenation Technology (ECMO) in Neonatal Respiratory Failure

Liyu Li¹; Jingguo Chen¹*; Qiaoru Li¹; Rukang Yuan¹; Tingbo Wu¹; Kaijun Zheng¹; Wenjing Xu¹; Yijuan Li²

¹The Affiliated Zhongshan Hospital, Sun Yat-sen University, China

²The First Affiliated Hospital, Sun Yat-sen University, China

*Corresponding author: Jingguo Chen The Affiliated Zhongshan Hospital, Sun Yat-sen University, Zhongshan, 528403, China. Email: chenjingguo@126.com

Received: June 24, 2023 Accepted: July 26, 2023 Published: August 02, 2023

Abstract

Objective: To explore the application of Extracorporeal Membrane Oxygenation technology (ECMO) in neonatal respiratory failure and provide guidance for future ECMO technology for critically ill newborns.

Methods: Retrospective analysis of the basic data, ECMO support process, and long-term neurological development of nine children supported by ECMO at Zhongshan People’s Hospital from January 2015 to August 2021.

Results: From January 2015 to August 2021, the number of admissions to the neonatal department of our hospital was 10,325, with 433 cases of neonatal respiratory failure, which was in line with ECMO support indication of 21 cases, of which 12 were non-ECMO groups and 12 were ECMO groups. In nine cases, the differences in sex, birth weight, gestational age, birth pattern, Apgar score, NCIS score, OI value, hospitalization days, mortality rate, and incidence of intracranial bleeding were not statistically significant (P>0.05). However, the average daily hospitalization cost for children in the ECMO group was significantly higher than that in the non-ECMO group, and the difference was statistically significant (P<0.05). ECMO after 12 h operation, arterial oxygen pressure, and intravenous oxygen saturation are substantially enhanced, while arterial carbon dioxide pressure oxygenation index is considerably reduced, with a statistically significant difference (P<0.05). ECMO pre-operation survival group lactic acid (6.46±2.70) was lower than the death group (17.66±14.62), after operation lactic acid decreased significantly, and after ECMO operation of the death group lactic acid showed an increase in conductivity. During the early stage of ECMO establishment, PT and APTT rapidly rise, while FIB decline. The ACT of both groups of children increased in the early stages of ECMO establishment and then gradually declined. In the ECMO group, seven children survived to discharge, six had no neurological developmental problems, and one had residual neurological sequelae.

Conclusion: ECMO can be employed as a complementary supportive treatment for newborns with respiratory failure, and the oxygenation condition can be effectively improved for newborns with respiratory failure who have failed to respond to traditional treatment.

Keywords: Newborns; Respiratory failure; In vitro membrane pulmonary oxygenation technology

Introduction

Extracorporeal Pulmonary Oxygenation (ECMO) is advanced in vitro life support system. However, the development of ECMO in China has been late and slow, with a modest number of clinical cases due to china's economic growth (Faith, 2020). In 2011, Guangdong was the first to report the use of ECMO to treat a case of fetus fecal inhalation syndrome of newborns and then ECMO technology in the domestic treatment of newborns. As of January 2019, China's ECMO technology had been applied to 89 newborns, with 33 cases (37.1%) of respiratory support, 43 cases (48.3%) of circulatory support, with survival rates of 66.7% and 37.2%, respectively [6]. Since January 2015, the Neonatal Unit of Zhongshan People's Hospital has used ECMO for neonatal care and treated a total of nine critically ill newborns by August 2021. This study retrospectively examines the critical respiratory failure newborns treated by ECMO technology, collects basic data, analyzes the treatment process and complications, and follows up with the neurodevelopment of discharged children. It also serves as a reference for future application of ECMO technology in critically ill newborns.

Data and Methods

Research Object Statistics

From January 2015 to August 2021, the number of cases diagnosed as neonatal respiratory failure in the neonatal department of Zhongshan People's Hospital, collects basic information on children who require ECMO support, and divides them into ECMO and non-ECMO groups based on whether or not ECMO support is needed. The non-ECMO group used ventilator and/or PS therapy to evaluate case data from both groups retrospectively.

Data Collection

We collected the general data on the two groups of children, including the gestational age, sex, birth weight, birth score, and compare the complications, mortality rate, hospital stay days, and medical expenses. Focused on the analysis of ECMO group children's auxiliary methods, diagnosis, and treatment process, and follow up the nervous system development of the ECMO group of surviving children.

Statistical Methods

All collected data are analyzed using SPSS 20.0 statistical software. The measurement data were normally tested by Shapiro-Wilk, the mean ± standard deviation of the normal distribution data, and the t-test was used to inter-group comparison. Non-normal distribution measurements are represented by the median (quartile spacing), while intergroup comparisons are measured using the Mann-Whitney U. The count data are described in frequency and percentage.

Results

General Information

From January 2015 to August 2021, the number of admissions to the neonatal department of our hospital was 10,325, with 433 cases (4.2%) of neonatal respiratory failure diagnosed, in line with the ECMO support index of 21 cases (0.2%). Fourteen (68.4%) were diagnosed with ARDS, whereas seven (31.8%) were diagnosed with Meconium Aspiration Syndrome (MAS).

In 12 cases the signatures had rejected the ECMO support due to economic conditions, including the non-ECMO group, and in nine cases signatures had agreed to ECMO support and were included in the ECMO group. In the non-ECMO group, there were 12 cases, with eight cases of men (66.7%) and four cases of women (33.3%). The average gestational age was 37 weeks, ranging from 34 weeks to 2 – 40 weeks to 4 weeks. The average birth weight was 2,680 g, ranging from 2,020 g to 3,560 g, with eight survivors (66.7%) and four deaths (33.3%). The ECMO group has nine cases, five cases for men (55.6%) and four cases for women (44.4%). The average gestational age was 38 weeks, ranging from 34 weeks to 3 to 40 plus 5 weeks. The average birth weight was 2,887 g, with a range of 2,130 g – 3,580 g with seven survived discharges (77.8%) and two deaths (22.2%). The differences in sex, birth weight, gestational age, birth pattern, NCIS score, OI value, number of days in the hospital, and incidence of intracranial bleeding were not statistically significant (P>0.05). The average hospitalization cost for children in the ECMO group was significantly higher than for children in the non-ECMO group, and the difference was statistically significant (P<0.05).

Changes in Laboratory Indicators in the Operation of ECMO

Changes in oxygenation indicators: Nine cases of ECMO in children after the establishment of 12 h arterial blood pressure divider (PaO2) with intravenous oxygen saturation (SaO2) were significantly higher than before, and arterial carbon dioxide pressure (PaCO2) and Oxygen Index (OI) were substantially lower than before, with statistically significant differences (P<0.05).

Changes in lactic acid values in ECMO operation: The survival group lactic acid before ECMO runs (6.46±2.70) was lower than lactic acid in the death group (17.66±14.62). However, after ECMO operation, the survival group lactic acid substantially reduced, while the death group lactic acid did not decrease significantly and increased in conductivity.

Changes in the function indicator of clotting during ECMO operation (Table 4 – Table 7): ECMO is established after the child’s clotting enzymes, Prothrombin Time (PT), and Activated Partial Thromboplastin Time (APTT) are quickly elevated. Through blood plasma infusion, adjustment is made to the gradual decrease in the amount of heparin. Fibrinogen (FIB) and Platelet count (PLT) decline in the early stages of ECMO establishment, but infusions of FIB, PLT, and ECMO begin to rise once the system is stabilized. Activated clotting time (ACT) at the beginning of ECMO establishment, they all increased with the adjustment of heparin dosage, ACT decrease by degree. The survival group stabilized at 160 – 200S after ECMO-assisted 24 h.