Alveolar-Arterial oxygen gradients versus the neonatal pulmonary insufficiency index for prediction of mortality in ECMO candidates

• Published in: Journal of pediatric surgery Vol. 19; no. 4; pp. 380 - 384
• Main Authors: Krummel, Thomas M., Greenfield, Lazar J., Kirkpatrick, Barry V., Mueller, Dawn G., Kerkering, Kathryn W., Ormazabal, Miguel, Napolitano, Anthony, Salzberg, Arnold M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.1984
• Subjects: Alveolar-arterial oxygen gradients; ECMO; Extracorporeal Circulation; Female; Fetal Hypoxia - metabolism; Fetal Hypoxia - physiopathology; Fetal Hypoxia - therapy; Humans; Infant, Newborn; neonatal pulmonary insufficiency index; Oxygen Consumption; Oxygen Inhalation Therapy; Pregnancy; Prognosis; Pulmonary Alveoli - metabolism; Respiratory Distress Syndrome, Newborn - physiopathology; Retrospective Studies; ECMO; neonatal pulmonary insufficiency index; Alveolar-arterial oxygen gradients
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/S0022-3468(84)80257-2

Current selection criteria necessary for intelligent application of extracorporeal membrane oxygenation (ECMO) in hypoxic neonates remains controversial. Both the Neonatal Pulmonary Insufficiency Index (NPII) and serial alveolar-arterial oxygenation gradient measurements (A-a)Do 2 have been recommended. Accordingly, an analysis of 50 consecutive severely hypoxic neonates was undertaken to assess the predictive value of (A-a)Do 2 determinations and NPII in discriminating survivors from nonsurvivors. These infants with meconium aspiration syndrome (MAS), congenital diaphragmatic hernia (CDH), or persistent pulmonary hypertension of the newborn (PPHN) required maximum mechanical ventilation for hypoxia. Pharmacologic manipulation of pulmonary vascular resistance was attempted in 83%. If postductal (A-a)Do 2 remained ≥620 torr despite 12 hours of maximum medical therapy, mortality was 100%; however, 35% of nonsurvivors were unfortunately excluded. (A-a)Do 2≥600 torr for 12 hours demonstrated 93.8% mortality, and only 12% of all mortalities were thus excluded. Among nonsurvivors successfully hyperventilated, the NPII could not predict mortality. Ideal selection criteria must exclude those who would otherwise survive without ECMO, yet allow early accurate identification of the neonate certain to die. It would appear that serial (A-a)Do 2 determinations best permit this identification and thus orderly application of ECMO.