Cardiopulmonary outcome of neonatal extracorporeal membrane oxygenation at ages 10-15 years

Objective: The purpose of this study was to evaluate the long-term cardiopulmonary outcome at ages 10-15 yrs following neonatal extracorporeal membrane oxygenation (ECMO). The specific aims of the study were to assess baseline aerobic capacity, cardiac function, and pulmonary function in neonatal ECMO survivors using graded exercise testing, echocardiography, and pulmonary function tests. Design: Cohort study. Setting; Exercise and pulmonary function laboratories of a large children's hospital. Patients: Seventeen 10- to 15-yr-old children treated with ECMO as neonates for meconium aspiration syndrome and 17 age-matched healthy controls. Interventions: Children were evaluated by use of physical exam, electrocardiogram, echocardiogram, treadmill stress test, and pulmonary function tests. Measurements and Main Results: Average weight, height, and age were similar between the groups. Both pre- and postexercise pulmonary function tests revealed air trapping and mild lower airway obstruction in the ECMO group, compared with mean pulmonary functions in the normal range for the control group. The mean forced expiratory volume in 1 sec, the forced expiratory flow between 25% and 75% of vital capacity, and the ratio between residual volume and total lung capacity were significantly different between the ECMO group and the control group. Although the ECMO group exhibited baseline and postexercise lung function abnormalities, there were no differences in maximal oxygen consumption between the two groups and all subjects reached anaerobic threshold. By regression analysis, the gestational age, duration of oxygen, and exercise score were significantly correlated with baseline lung function, using forced expiratory flow between 25% and 75% of vital capacity as the dependent variable. Conclusions: Despite abnormalities in baseline and postexercise pulmonary functions, ECMO graduates have similar aerobic capacity to age-matched healthy controls. The most significant factor in predicting long-term pulmonary outcome in ECMO graduates is the duration of oxygen use following decannulation.