Objective: We determined clinical characteristics of cardiorespiratory failure treated with ECMO that may contribute towards the development of cerebral palsy (CP), mental retardation (MR), and sensorineural hearing loss (HL) in some survivors.

Methods: Of 285 ECMO treated neonates followed prospectively(June, 1985-July, 1994), 236 (83%) survived. Of these, 212 (90%) have had comprehensive neurodevelopmental evaluations at ≥1 year. Neonatal diagnoses, lowest pH, PaO2, PaCO2 and systolic blood pressure (BPsys), pre-bypass oxygen index (OI), hours of life before and on ECMO, need for resuscitation (CPR), etc were recorded. Thirty-four children who were normal at 4.8-6.0 years on IQ (WPPSI-R), neurological and on behavioral audiometric testing were compared to 17 others with CP identified by 15 months of age (10 with MR also), and to 12 identified by 14-60 months with HL without MR or CP. Univariate analysis was performed, and odds ratios (OR) with 95% confidence limits (95% CL) were calculated.

Results: CP was preceded by a higher OI (P=.015) and need for CPR(P<.0001) pre-ECMO, a lower pH on ECMO (P=.043), and lower BPsys before or during ECMO (P=.0093). A lowest BPsys ≤38 mm Hg gave OR=5.3 for CP (95% CL 1.2-24.5). Sensorineural HL was preceded by a lower PaCO2 pre-ECMO (P=.0003), a longer duration to ECMO onset (P=.02), and a lower OI pre-ECMO (P=.015). A lowest PaCO2 ≤14 mm Hg gave OR=29.1 for subsequent HL (95% CL 4.0-210).

Conclusions: Low blood pressure (BPsys ≤38 mm Hg) should be treated vigorously (volume and vasopressor infusions) both before andon ECMO, and need for CPR avoided. Prolonged hyperventilation alkylosis (PaCO2 ≤14 mm Hg) should also be avoided prior to ECMO. Earlier initiation criteria for ECMO should be investigated.

NIH NS 27463, 21453