From Jan 1991 to Sept 1994, 79 neonates were treated with ECMO in the Netherlands in a study granted by the National Board of Health Care Insurances. The study was designed as an open prospective trial. The survival of the ECMO patients was compared with historical controls, born in the pre-ECMO period, who were recruted in all Dutch NICU'S and pediatric(surgery) intensive care units. All controls, born between 1988 and 1990, fullfilled ECMO criteria. The efficacy of ECMO in three subgroups [MAS, CDH and Other Diagnoses (OD) such as pneumonia, sepsis, RDS, and PPHN] was tested with the chi square test. Survival rates of controls versus ECMO patients was expressed by the Odds Ratio (OR).

Overall survival in the control group (CT) group (n=84) was 32% and with ECMO 76%; OR 0.15, p<0.001. In the subgroup with MAS, the survival in the CT group (n=22) was 50% and 87% with ECMO(n=31); OR 0.15, p=0.005. In the CDH group with 24 CT patients 4% survived and with ECMO(n=23) 65%; OR 0.02, p<0.001. In the group OD 39% of the CT (n=38) and 72% of the ECMO patients(n= 25) suvived; OR 0.25, p=0.002.

The need for ECMO can be calculated from these data. In the pre-ECMO period 1 of 6825 live birth met ECMO criteria, while in 1992 one of 6540 was treated with ECMO. Conclusion: Compared to conventionel therapy, patients treated with ECMO show significantly higher survival rates. Although mortality in controls, fullfilling ECMO criteria, was 50% in the MAS group and 61% in the OD group, ECMO treatment showed significantly better suvival. Mortality risk in CDH is higher than 80% when they meet ECMO entry criteria, adaptation seems to be necessary. In the Netherlands the number of newborns fullfilling ECMO criteria, respectively the number of ECMO treated newborns, are considerably lower than reported from the United States.