How low can you go? Effectiveness and safety of extracorporeal membrane oxygenation in low-birth-weight neonates

Purpose: Controversy exists regarding the criteria for placement of infants on extracorporeal membrane oxygenation (ECMO) at low birth weights. The authors hypothesized that ECMO is effective and safe in babies under 2 kg and sought to examine outcome and survival rate in these infants. Methods: All patients less than 30 days old in the Extracorporeal Life Support Organization (ELSO) registry (n = 14,305) were divided into those less than 2 kg (n = 663) and more than 2 kg (n = 13,642). Multiple regression analysis determined factors that predicted survival rate and the lowest safe weight for ECMO. Results: Overall survival rate was 76% and was lower in infants less than 2 kg (greater than or equal to2 kg, 77% v <2 kg, 53%, P < .0001). Survival rate was significantly lower for patients with diaphragmatic hernia (CDH), bleeding, and intracranial hemorrhage (ICH) by regression. The incidence of ICH in babies less than 2.0 kg was 6% versus 4% in those more than 2.0 kg (P < .05). Regression analysis determined that the lowest weight at which a survival rate of 40% could be achieved was 1.6 kg. Conclusions: Cannulation for ECMO may be safe and effective in babies under 2.0 kg and potentially as low as 1.6 kg. Judicious anticoagulation might limit bleeding, which occurred in a minority of these patients. (C) 2004 Elsevier Inc. All rights reserved.