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Venovenous versus venoarterial extracorporeal membrane oxygenation among infants with hypoxic-ischemic encephalopathy: is there a difference in outcome?

Journal of Perinatology volume 41, pages 1916–1923 (2021)Cite this article

Subjects

Abstract

Objective

Our hypothesis was that among infants with hypoxic-ischemic encephalopathy (HIE), venoarterial (VA), compared to venovenous (VV), extracorporeal membrane oxygenation (ECMO) is associated with an increased risk of mortality or intracranial hemorrhage (ICH).

Design/methods

Retrospective cohort analysis of infants in the Children’s Hospitals Neonatal Database from 2010 to 2016 with moderate or severe HIE, gestational age ≥36 weeks, and ECMO initiation <7 days of age. The primary outcome was mortality or ICH.

Results

Severe HIE was more common in the VA ECMO group (n = 57), compared to the VV ECMO group (n = 53) (47.4% vs. 26.4%, P = 0.02). VA ECMO was associated with a significantly higher risk of death or ICH [57.9% vs. 34.0%, aOR 2.39 (1.08–5.28)] and mortality [31.6% vs. 11.3%, aOR 3.06 (1.08–8.68)], after adjusting for HIE severity.

Conclusions

In HIE, VA ECMO was associated with a higher incidence of mortality or ICH. VV ECMO may be beneficial in this population.

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Fig. 1: Flow diagram of participants.

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References

  1. Shankaran S, Laptook AR, Pappas A, McDonald SA, Das A, Tyson JE, et al. Effect of depth and duration of cooling on death or disability at age 18 months among neonates with hypoxic-ischemic encephalopathy: a randomized clinical trial. JAMA. 2017;318:57–67.

    Article  Google Scholar 

  2. Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy. Early Hum Dev. 2010;86:329–38.

    Article  Google Scholar 

  3. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013;1:CD003311.

    Google Scholar 

  4. Lakshminrusimha S, Saugstad OD. The fetal circulation, pathophysiology of hypoxemic respiratory failure and pulmonary hypertension in neonates, and the role of oxygen therapy. J Perinatol. 2016;36:S3–S11.

    Article  Google Scholar 

  5. Lapointe A, Barrington KJ. Pulmonary hypertension and the asphyxiated newborn. J Pediatr. 2011;158:e19–24.

    Article  Google Scholar 

  6. Benumof JL, Wahrenbrock EA. Dependency of hypoxic pulmonary vasoconstriction on temperature. J Appl Physiol Respir Environ Exerc Physiol. 1977;42:56–8.

    CAS  PubMed  Google Scholar 

  7. Toubas PL, Hof RP, Heymann MA, Rudolph AM. Effects of hypothermia and rewarming on the neonatal circulation. Arch Fr Pediatr. 1978;35:84–92.

    CAS  PubMed  Google Scholar 

  8. Bulas DI, Taylor GA, O’Donnell RM, Short BL, Fitz CR, Vezina G. Intracranial abnormalities in infants treated with extracorporeal membrane oxygenation: update on sonographic and CT findings. AJNR Am J Neuroradiol. 1996;17:287–94.

    CAS  PubMed  Google Scholar 

  9. Shankaran S, Pappas A, Laptook AR, McDonald SA, Ehrenkranz RA, Tyson JE, et al. Outcomes of safety and effectiveness in a multicenter randomized, controlled trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy. Pediatrics. 2008;122:e791–8.

    Article  Google Scholar 

  10. Shankaran S, Laptook AR, Pappas A, McDonald SA, Das A, Tyson JE, et al. Effect of depth and duration of cooling on deaths in the NICU among neonates with hypoxic ischemic encephalopathy: a randomized clinical trial. JAMA. 2014;312:2629–39.

    Article  CAS  Google Scholar 

  11. Rutherford MA, Azzopardi D, Whitelaw A, Cowan F, Renowden S, Edwards AD. et al. Mild hypothermia and the distribution of cerebral lesions in neonates with hypoxic-ischemic encephalopathy. Pediatrics. 2005;116:1001–6.

    Article  Google Scholar 

  12. Shankaran S, Barnes PD, Hintz SR, Laptook AR, Zaterka-Baxter KM, McDonald SA. et al. Brain injury following trial of hypothermia for neonatal hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2012;97:F398–404.

    PubMed  Google Scholar 

  13. Cuevas Guaman M, Lucke AM, Hagan JL, Kaiser JR. Bleeding complications and mortality in neonates receiving therapeutic hypothermia and extracorporeal membrane oxygenation. Am J Perinatol. 2018;35:271–6.

    Article  Google Scholar 

  14. Skinner SC, Iocono JA, Ballard HO, Turner MD, Ward AN, Davenport DL, et al. Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the extracorporeal life support organization registry. J Pediatr Surg. 2012;47:63–7.

    Article  Google Scholar 

  15. Cashen K, Reeder RW, Shanti C, Dalton HJ, Dean JM, Meert KL. et al. Is therapeutic hypothermia during neonatal extracorporeal membrane oxygenation associated with intracranial hemorrhage?. Perfusion. 2018;33:354–62.

    Article  Google Scholar 

  16. Carpenter JL, Yu YR, Cass DL, Olutoye OO, Thomas JA, Burgman C, et al. Use of venovenous ECMO for neonatal and pediatric ECMO: a decade of experience at a tertiary children’s hospital. Pediatr Surg Int. 2018;34:263–8.

    Article  Google Scholar 

  17. Murthy K, Dykes FD, Padula MA, Pallotto EK, Reber KM, Durand DJ, et al. The Children’s Hospitals neonatal database: an overview of patient complexity, outcomes and variation in care. J Perinatol. 2014;34:582–6.

    Article  CAS  Google Scholar 

  18. Massaro AN, Murthy K, Zaniletti I, Cook N, DiGeronimo R, Dizon ML, et al. Intercenter cost variation for perinatal hypoxic-ischemic encephalopathy in the era of therapeutic hypothermia. J Pediatr. 2016;173:76–83. e1

    Article  Google Scholar 

  19. Shankaran S, Laptook AR, Ehrenkranz RA, Tyson JE, McDonald SA, Donovan EF, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med. 2005;353:1574–84.

    Article  CAS  Google Scholar 

  20. Pfister RH, Bingham P, Edwards EM, Horbar JD, Kenny MJ, Inder T, et al. The vermont oxford neonatal encephalopathy registry: rationale, methods, and initial results. BMC Pediatr. 2012;12:84.

    Article  Google Scholar 

  21. Agarwal P, Altinok D, Desai J, Shanti C, Natarajan G. In-hospital outcomes of neonates with hypoxic-ischemic encephalopathy receiving extracorporeal membrane oxygenation. J Perinatol. 2019;39:661–5.

    Article  Google Scholar 

  22. Polito A, Barrett CS, Wypij D, Rycus PT, Netto R, Cogo PE, et al. Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO registry data. Intensive Care Med. 2013;39:1594–601.

    Article  CAS  Google Scholar 

  23. Howard TS, Kalish BT, Rajagopal SK, Williams K, Zalieckas J, Thiagarajan RR, et al. Factors associated with mortality in children who successfully wean from extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2018;19:875–83.

    Article  Google Scholar 

  24. Melbourne L, Wien MA, Whitehead MT, Ridore M, Wang Y, Short BL, et al. Risk factors for brain injury in newborns treated with extracorporeal membrane oxygenation. Am J Perinatol. 2020. https://doi.org/10.1055/s-0040-1714208. [Epub ahead of print].

  25. de Mol AC, Liem KD, van Heijst AF. Cerebral aspects of neonatal extracorporeal membrane oxygenation: a review. Neonatology. 2013;104:95–103.

    Article  Google Scholar 

  26. Short BL, Bender K, Walker LK, Traystman RJ. The cerebrovascular response to prolonged hypoxia with carotid artery and jugular vein ligation in the newborn lamb. J Pediatr Surg. 1994;29:887–91.

    Article  CAS  Google Scholar 

  27. Short BL, Walker LK, Traystman RJ. Impaired cerebral autoregulation in the newborn lamb during recovery from severe, prolonged hypoxia, combined with carotid artery and jugular vein ligation. Crit Care Med. 1994;22:1262–8.

    Article  CAS  Google Scholar 

  28. Short BL. The effect of extracorporeal life support on the brain: a focus on ECMO. Semin Perinatol. 2005;29:45–50.

    Article  Google Scholar 

  29. Guner YS, Harting MT, Fairbairn K, Delaplain PT, Zhang L, Chen Y, et al. Outcomes of infants with congenital diaphragmatic hernia treated with venovenous versus venoarterial extracorporeal membrane oxygenation: a propensity score approach. J Pediatr Surg. 2018;53:2092–9.

    Article  Google Scholar 

  30. Puligandla PS, Grabowski J, Austin M, Hedrick H, Renaud E, Arnold M, et al. Management of congenital diaphragmatic hernia: a systematic review from the APSA outcomes and evidence based practice committee. J Pediatr Surg. 2015;50:1958–70.

    Article  Google Scholar 

  31. Meek JH, Elwell CE, McCormick DC, Edwards AD, Townsend JP, Stewart AL, et al. Abnormal cerebral haemodynamics in perinatally asphyxiated neonates related to outcome. Arch Dis Child Fetal Neonatal Ed. 1999;81:F110–5.

    Article  CAS  Google Scholar 

  32. Pryds O, Greisen G, Lou H, Friis-Hansen B. Vasoparalysis associated with brain damage in asphyxiated term infants. J Pediatr. 1990;117:119–25.

    Article  CAS  Google Scholar 

  33. Sewell EK, Piazza AJ, Davis J, Heard ML, Figueroa J, Keene SD. Inotrope needs in neonates requiring extracorporeal membrane oxygenation for respiratory failure. J Pediatrics. 2019;214:128–33.

    Article  Google Scholar 

  34. Origen: December 2019 statement from Richard Martin CoB, Origen Biomedical. https://www.origen.com/wp-content/uploads/Catheter.update.pdf.

  35. Johnson SM, Itoga N, Garnett GM, Kilcommons M, Puapong DP, Woo RK. Increased risk of cardiovascular perforation during ECMO with a bicaval, wire-reinforced cannula. J Pediatr Surg. 2014;49:46–9. discussion 9-50

    Article  Google Scholar 

  36. Speggiorin S, Robinson SG, Harvey C, Westrope C, Faulkner GM, Kirkland P, et al. Experience with the Avalon(R) bicaval double-lumen veno-venous cannula for neonatal respiratory ECMO. Perfusion. 2015;30:250–4.

    Article  CAS  Google Scholar 

  37. Lillie J, Boot L, Speggiorin S, Nyman AG. Factors behind decline of venovenous extracorporeal membrane oxygenation to support neonatal respiratory failure. Pediatr Crit Care Med. 2020;21:e502–e4.

    Article  Google Scholar 

  38. Extracorporeal Life Support Organisation: International Trend Report July Aahweo.

  39. Roberts J, Keene S, Heard M, McCracken C, Gauthier TW. Successful primary use of VVDL+V ECMO with cephalic drain in neonatal respiratory failure. J Perinatol. 2016;36:126–31.

    Article  CAS  Google Scholar 

  40. Griffin MP, Minifee PK, Landry SH, Allison PL, Swischuk LE, Zwischenberger JB. Neurodevelopmental outcome in neonates after extracorporeal membrane oxygenation: cranial magnetic resonance imaging and ultrasonography correlation. J Pediatr Surg. 1992;27:33–5.

    Article  CAS  Google Scholar 

  41. Bulas D, Glass P. Neonatal ECMO: neuroimaging and neurodevelopmental outcome. Semin Perinatol. 2005;29:58–65.

    Article  Google Scholar 

  42. Massaro AN, Murthy K, Zaniletti I, Cook N, DiGeronimo R, Dizon M, et al. Short-term outcomes after perinatal hypoxic ischemic encephalopathy: a report from the Children’s Hospitals Neonatal Consortium HIE focus group. J Perinatol. 2015;35:290–6.

    Article  CAS  Google Scholar 

Download references

Children’s Hospital Neonatal Consortium (CHNC) ECMO and HIE focus groups

Anthony Piazza14, Gregory Sysyn15, Carl Coghill16, Allison Black16, Ramasubbareddy Dhanireddy17, Anne Hansen18, Tanzeema Hossain18, Karna Murthy19, Gustave Falciglia19, Beth Haberman20, Amy Nathan20, Kristin Nelson20, Paul Kingma20, Stefanie Riddle20, Stephanie Merhar20, Heather Kaplan20, Kristina Reber21, Rashmin Savani22, Luc Brion22, Noorjahan Ali22, Theresa Grover23, Girija Natarajan24, Jonathan Nedrelow25, Annie Chi25, Yvette Johnson25, Gautham Suresh26, William Engle27, Lora Simpson27, Gregory Sokol27, Eugenia Pallotto28, Robert Lyle29, Becky Rogers29, Steven Chin30, Rachel Chapman30, Jamie Limjoco31, Lori Haack31, David Durand32, Jeanette Asselin32, Art D’Harlingue32, Priscilla Joe32, Jacquelyn Evans33, Michael Padula33, David Munson33, Suzanne Touch34, Toby Yanowitz35, Beverly Brozanski36, Rakesh Rao36, Victor McKay37, Mark Speziale38, Brian Lane38, Laural Moyer38, Billie Short39, Lamia Soghier39, Kevin Sullivan40, Con Yee Ling41, Shrena Patel41, Michael Uhing42, Ankur Datta42, Nicole Birge43, Rajan Wadhawan44, Elizabeth Jacobsen-Misbe45, Robert DiGeronimo45, Zeenia Billimoria45, Kyong-Soon Lee46, Michel Mikhael47, Irfan Ahmad47.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital of Michigan/Central Michigan University, Detroit, MI, USA

    Prashant Agarwal & Girija Natarajan

  2. Department of Pediatrics, AI duPont Hospital for Children/Thomas Jefferson University, Wilmington, DE, USA

    Kevin Sullivan

  3. Department of Pediatrics, Washington University in St. Louis, St Louis, MO, USA

    Rakesh Rao

  4. Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Natalie Rintoul

  5. Children’s Hospital Association, Lenexa, KS, USA

    Isabella Zaniletti

  6. Department of Pediatrics, Children’s Healthcare of Atlanta and Emory University, Atlanta, GA, USA

    Sarah Keene & Shannon Hamrick

  7. Department of Pediatrics, Seattle Children’s Hospital/University of Washington, Seattle, WA, USA

    Ulrike Mietzsch, Zeenia Billimoria & Robert DiGeronimo

  8. Department of Pediatrics, The George Washington University School of Medicine and Children’s National Hospital, Washington DC, DC, USA

    An N. Massaro

  9. Department of Pediatrics, AI duPont Hospital for Children, Wilmington, DE, USA

    Daniel Dirnberger

  10. Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA

    Ruth B. Seabrook

  11. Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA

    Mark F. Weems

  12. Department of Pediatrics, Children’s Hospital of Orange County, Orange, CA, USA

    John P. Cleary

  13. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Brian W. Gray

  14. Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Anthony Piazza

  15. Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA

    Gregory Sysyn

  16. Children’s Hospital of Alabama, Birmingham, AL, USA

    Carl Coghill & Allison Black

  17. Le Bonheur Children’s Hospital, Memphis, TN, USA

    Ramasubbareddy Dhanireddy

  18. Children’s Hospital Boston, Boston, MA, USA

    Anne Hansen & Tanzeema Hossain

  19. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Karna Murthy & Gustave Falciglia

  20. Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Beth Haberman, Amy Nathan, Kristin Nelson, Paul Kingma, Stefanie Riddle, Stephanie Merhar & Heather Kaplan

  21. Nationwide Children’s Hospital, Columbus, OH, USA

    Kristina Reber

  22. Children’s Medical Center, Dallas, TX, USA

    Rashmin Savani, Luc Brion & Noorjahan Ali

  23. Children’s Hospital Colorado, Aurora, CO, USA

    Theresa Grover

  24. Children’s Hospital of Michigan, Detroit, MI, USA

    Girija Natarajan

  25. Cook Children’s Health Care System, Fort Worth, TX, USA

    Jonathan Nedrelow, Annie Chi & Yvette Johnson

  26. Texas Children’s Hospital, Houston, TX, USA

    Gautham Suresh

  27. Riley Children’s Hospital, Indianapolis, IN, USA

    William Engle, Lora Simpson & Gregory Sokol

  28. Children’s Mercy Hospitals & Clinics, Kansas City, MO, USA

    Eugenia Pallotto

  29. Arkansas Children’s Hospital, Little Rock, AR, USA

    Robert Lyle & Becky Rogers

  30. Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Steven Chin & Rachel Chapman

  31. American Family Children’s Hospital, Madison, WI, USA

    Jamie Limjoco & Lori Haack

  32. Children’s Hospital & Research Center Oakland, Oakland, CA, USA

    David Durand, Jeanette Asselin, Art D’Harlingue & Priscilla Joe

  33. The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Jacquelyn Evans, Michael Padula & David Munson

  34. St. Christopher’s Hospital for Children, Philadelphia, PA, USA

    Suzanne Touch

  35. Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA

    Toby Yanowitz

  36. St. Louis Children’s Hospital, St Louis, MO, USA

    Beverly Brozanski & Rakesh Rao

  37. All Children’s Hospital, St. Petersburg, FL, USA

    Victor McKay

  38. Rady Children’s Hospital, San Diego, CA, USA

    Mark Speziale, Brian Lane & Laural Moyer

  39. Children’s National Medical Center, Washington, DC, USA

    Billie Short & Lamia Soghier

  40. AI DuPont Hospital for Children, Wilmington, DE, USA

    Kevin Sullivan

  41. Primary Children’s Medical Center, Salt Lake City, UT, USA

    Con Yee Ling & Shrena Patel

  42. Children’s Hospital of Wisconsin, Milwaukee, WI, USA

    Michael Uhing & Ankur Datta

  43. Children’s Hospital & Medical Center, Omaha, NE, USA

    Nicole Birge

  44. Florida Hospital for Children, Florida, USA

    Rajan Wadhawan

  45. Seattle Children’s Hospital, Seattle, WA, USA

    Elizabeth Jacobsen-Misbe, Robert DiGeronimo & Zeenia Billimoria

  46. Hospital for Sick Children, Toronto, ON, USA

    Kyong-Soon Lee

  47. Children’s Hospital Orange County, Los Angeles, CA, USA

    Michel Mikhael & Irfan Ahmad

Authors
  1. Prashant Agarwal
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  2. Girija Natarajan
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  3. Kevin Sullivan
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  4. Rakesh Rao
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  5. Natalie Rintoul
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  6. Isabella Zaniletti
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  7. Sarah Keene
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  8. Ulrike Mietzsch
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  9. An N. Massaro
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  10. Zeenia Billimoria
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  11. Daniel Dirnberger
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  12. Shannon Hamrick
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  13. Ruth B. Seabrook
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  14. Mark F. Weems
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  15. John P. Cleary
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  16. Brian W. Gray
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  17. Robert DiGeronimo
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Consortia

for the Children’s Hospital Neonatal Consortium (CHNC) ECMO and HIE focus groups

  • Anthony Piazza
  • , Gregory Sysyn
  • , Carl Coghill
  • , Allison Black
  • , Ramasubbareddy Dhanireddy
  • , Anne Hansen
  • , Tanzeema Hossain
  • , Karna Murthy
  • , Gustave Falciglia
  • , Beth Haberman
  • , Amy Nathan
  • , Kristin Nelson
  • , Paul Kingma
  • , Stefanie Riddle
  • , Stephanie Merhar
  • , Heather Kaplan
  • , Kristina Reber
  • , Rashmin Savani
  • , Luc Brion
  • , Noorjahan Ali
  • , Theresa Grover
  • , Girija Natarajan
  • , Jonathan Nedrelow
  • , Annie Chi
  • , Yvette Johnson
  • , Gautham Suresh
  • , William Engle
  • , Lora Simpson
  • , Gregory Sokol
  • , Eugenia Pallotto
  • , Robert Lyle
  • , Becky Rogers
  • , Steven Chin
  • , Rachel Chapman
  • , Jamie Limjoco
  • , Lori Haack
  • , David Durand
  • , Jeanette Asselin
  • , Art D’Harlingue
  • , Priscilla Joe
  • , Jacquelyn Evans
  • , Michael Padula
  • , David Munson
  • , Suzanne Touch
  • , Toby Yanowitz
  • , Beverly Brozanski
  • , Rakesh Rao
  • , Victor McKay
  • , Mark Speziale
  • , Brian Lane
  • , Laural Moyer
  • , Billie Short
  • , Lamia Soghier
  • , Kevin Sullivan
  • , Con Yee Ling
  • , Shrena Patel
  • , Michael Uhing
  • , Ankur Datta
  • , Nicole Birge
  • , Rajan Wadhawan
  • , Elizabeth Jacobsen-Misbe
  • , Robert DiGeronimo
  • , Zeenia Billimoria
  • , Kyong-Soon Lee
  • , Michel Mikhael
  •  & Irfan Ahmad

Corresponding author

Correspondence to Prashant Agarwal.

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Members of the Children’s Hospital Neonatal Consortium (CHNC) ECMO and HIE focus groups are listed above Conflict of interest.

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Agarwal, P., Natarajan, G., Sullivan, K. et al. Venovenous versus venoarterial extracorporeal membrane oxygenation among infants with hypoxic-ischemic encephalopathy: is there a difference in outcome?. J Perinatol 41, 1916–1923 (2021). https://doi.org/10.1038/s41372-021-01089-4

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