Efficacy and economy of inhaled nitric oxide in neonates accepted for extra-corporeal membrane oxygenation

Objective: To study the clinical efficacy as well as the cost-effectiveness of inhaled nitric oxide (NO) compared with extra-corporeal membrane oxygenation (ECMO) in neonates with pulmonary hypertension and hypoxic respiratory failure accepted for ECMO treatment. Design: Retrospective study of the first 10 consecutive neonatal patients treated with inhaled NO during 1992-94. Inhaled NO was administered after failure of conventional treatment as a last resort before initiating ECMO. For cost-effectiveness calculations the above-described patient population was compared with ECMO patients having a very favourable ECMO course. Setting: Twelve-bed neonatal and paediatric intensive care unit with ECMO capabilities at a tertiary university referral hospital. Results. Inhaled NO was found to significantly decrease the oxygenation index (OI pre-NO: median 80.5; OI post-NO. median 22.5; P = 0.003) and five of the patients could successfully be handled without the use of ECMO. ECMO was found to be more than four times as expensive as inhaled NO treatment on a per hour basis ($244 vs. $53 per hour) and the net savings from being able to avoid ECMO in five patients was calculated to be $156 200. Conclusion: initiation of inhaled NO caused a significant improvement in oxygenation index and reduced the need for ECMO by 50% in critically ill neonatal patients with hypoxic respiratory failure. Inhaled NO was also found to compare very favourably with ECMO regarding cost-effectiveness ($53 vs. $244 per treatment hour).