Neonatal extracorporeal life support: impact of new therapies on survival

J Pediatr. 2006 May;148(5):595-9. doi: 10.1016/j.jpeds.2005.12.024.


Objective: To evaluate the effects of pre-extracorporeal life support (ECLS) management with nitric oxide (NO), high frequency ventilation (HFV), and surfactant on mortality among neonates supported with ECLS.

Study design: Extracorporeal Life Support Organization (ELSO) data on 7017 neonates cannulated for respiratory reasons between 1996 and 2003 were analyzed using chi2, analysis of variance, and logistic regression.

Results: The use of ECLS declined by 26.6% over the study period with no significant change in mortality. Unadjusted ECLS mortality for NO-treated patients was lower than for infants not treated with NO (25.1% vs 28.6%, P = .0012) and for infants treated with surfactant than for infants not treated with surfactant (18.7% vs 30.3%, p <.0001.) Unadjusted mortality for HFV-treated patients was no different than for non-HFV-treated patients (26.0% vs 26.6%, P = .56). After adjusting for confounders (primary diagnosis, age at cannulation, ECMO year 1996-1999 vs 2000-2003), surfactant use was associated with decreased mortality. NO-treated neonates were less likely to have a pre-ECLS cardiopulmonary arrest than infants not treated with NO. NO, HFV, and surfactant were not associated with prolongation of ECLS or mechanical ventilation.

Conclusions: NO, HFV, and surfactant were not associated with increased mortality in neonates who require ECLS for hypoxic respiratory failure.

MeSH terms

  • Bronchodilator Agents / therapeutic use
  • Extracorporeal Membrane Oxygenation*
  • High-Frequency Ventilation
  • Humans
  • Infant
  • Infant, Newborn
  • Nitric Oxide / therapeutic use
  • Pulmonary Surfactants / therapeutic use
  • Registries
  • Respiratory Insufficiency / congenital
  • Respiratory Insufficiency / mortality*
  • Respiratory Insufficiency / therapy*
  • Retrospective Studies
  • Survival Rate


  • Bronchodilator Agents
  • Pulmonary Surfactants
  • Nitric Oxide