Referral pattern of neonates with severe respiratory failure for extracorporeal membrane oxygenation

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) remains the mainstay of management in neonates with severe but potentially reversible respiratory failure. ECMO is available only as supra-regional service in 4 centres in the UK.

Objective: To explore regional variations in ECMO referrals and neonatal deaths due to severe respiratory failure in England, Wales and Northern Ireland.

Methods: In this retrospective study, data regarding ECMO referrals due to neonatal respiratory failure were obtained from the four UK ECMO centres between January 2000 and December 2002 and then subdivided according to the Government Office Regions. Anonymised data regarding neonatal deaths was obtained from Confidential Enquiry into Maternal and Child Health. Neonatal deaths were classified into 4 groups; Group I: Deaths potentially avoidable by ECMO, Group II: Deaths where it is unclear whether ECMO would be of benefit, Group III: Neonates not eligible for ECMO and Group IV: Data inadequate to classify deaths.

Results: There was a significant regional variation in both ECMO referral rate (0.10 to 0.46 per 1000 live births), and neonatal death (Group I and II) rates (0.09 to 0.32 per 1000 live births). Regions with high referral rates for ECMO tended towards having higher group I plus group II neonatal death rates (correlation coefficient =0.75).

Conclusion: It is possible that there are significant regional variations in the uptake of ECMO and in neonatal mortality due to severe respiratory failure. A confidential prospective study may further clarify these observations and could identify the factors that could lead to these variations.