Considerable work has been done to demonstrate the effectiveness of extracorporeal membrane oxygenation (ECMO) for certain neonates in imminent danger of death from a narrow range of conditions causing hypoxemia and respiratory distress not responsive to other forms of therapy. Many clinicians are convinced that infants with congenital diaphragmatic hernia and other forms of persistent transitional circulation with pulmonary hypertension, unresponsive to more conventional forms of respiratory support, have been saved through the use of ECMO. However, experience with ECMO has been quite individualized, seldom studied prospectively, and based on criteria that are not generalizable between institutions. Data concerning the longer term outcome of patients who have been treated with ECMO are sparse, and concerns persist about the consequences of carotid artery and/or jugular vein ligation, prolonged anticoagulation, and long-term circulatory bypass. There is a clear need for more information about this technique. Nevertheless, it appears that new ECMO centers are evolving on the basis of current enthusiasm and without a thorough appreciation of the complexity, intensity, potential hazards, and uncertainties of this form of therapy.
The committee makes the following recommendations.
1. The establishment of an ECMO center for newborn infants should occur only when a regional requirement for one has been demonstrated. In addition, the proposed center must demonstrate (a) the ability to manage a stable and successful regional neonatal/perinatal care program, (b) the availability and skills of appropriate personnel to perform ECMO, and (c) ready access to an organized functioning neonatal transport system.
2. ECMO centers should be established only in institutions with a recognized level III regionnal neonatal/perinatal center with appropriate coverage by pediatric medical and surgical subspecialists.