Recent Study Finds Benefits of ECMO during Therapeutic Hypothermia for Infants with HIE
Babies with hypoxic-ischemic encephalopathy (HIE) often experience respiratory problems. Because of this, they may require assistance with breathing after birth. This can be done through the urgent method of resuscitation, or the more long-term assistance of inhaled nitric acid, high-frequency ventilation, or extracorporeal membrane oxygenation (ECMO) (1). These long-term practices are commonly used for neonates with HIE and persistent pulmonary hypertension.
ECMO is a common treatment for babies with respiratory issues that employs a pump to circulate the baby’s blood through an artificial lung to help with oxygenation (2). In so doing, ECMO treatments allow the baby’s heart and lungs to rest or heal. ECMO does have its risks, such as bleeding, infection, transfusion problems, and blood clot formation. Babies placed on ECMO are usually in serious need of respiratory intervention, and therefore the benefits of ECMO normally outweigh these risks.
The standard treatment for HIE is therapeutic hypothermia (TH). The use of TH during ECMO has been gaining interest among physicians, but there hasn’t been enough data to support clinical use (3). In a 2017 study, it was found that the combined use of ECMO and TH was associated with increased risk of intracranial hemorrhage.
A study that was just published in 2019 sought to determine the outcomes for infants with HIE who required ECMO (4). It found that, of the 20 infants who received hypothermia therapy, 30% developed intracranial hemorrhage during ECMO and 16 survived through their hospital stay until discharge. Of the 16 survivors, 15 had an MRI; seven had normal MRIs, three showed evidence of intracranial hemorrhage, and five had brain injuries. The use of ECMO in these very severely injured infants was proven to be beneficial.
Because physicians haven’t always felt comfortable using ECMO with TH treatments, a2018 study aimed to survey physicians, medical directors, and ECMO directors in various facilities across the U.S. and Canada about these treatments (5). It found that 72% of those who responded to the survey initiated or referred for ECMO during cooling therapy for infants with HIE, which is an increase from a similar survey done in 2008. It also noted that neonatologists were more likely than non-neonatologists to use ECMO, or offer it as a treatment, for infants with mild or moderate encephalopathy. Since therapeutic hypothermia has become the standard of care for HIE, ECMO use has increased.
The use of ECMO during TH treatments is still not common practice and the limitations of its usage are still being studied. Let us know your thoughts on this recent study in the comments!
- (n.d.). Retrieved November 19, 2018, from https://www.uptodate.com/contents/clinical-features-diagnosis-and-treatment-of-neonatal-encephalopathy
- Extracorporeal membrane oxygenation: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved March 22, 2019, from https://medlineplus.gov/ency/article/007234.htm
- Cashen, K., Reeder, R., & Shanti, C. (2017, December 11). Is therapeutic hypothermia during neonatal extracorporeal membrane oxygenation associated with intracranial hemorrhage? Retrieved March 22, 2019, from https://journals.sagepub.com/doi/abs/10.1177/0267659117747693
- Agarwal, P., Altinok, D., Desai, J., Shanti, C., & Natarajan, G. (2019, March 06). In-hospital outcomes of neonates with hypoxic-ischemic encephalopathy receiving extracorporeal membrane oxygenation. Retrieved March 22, 2019, from https://www.nature.com/articles/s41372-019-0345-6
- Weems, M. F., Upadhyay, K., & Sandhu, H. S. (2018, September). Survey of ECMO practices for infants with hypoxic ischemic encephalopathy. Retrieved March 22, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/30046182