Abstract
Introduction: NO has been shown to decrease ECMO use in neonates but its effect on ECMO utilization in older patients is unclear. We use INO in an algorithm of treatment for severe RF prior to ECMO rescue. We hypothesized that use of INO reduces the need for ECMO. Methods: Since 1994,10/19 patients receiving INO were ECMO candidates. Criteria for use of INO are : age newborn to 65 yrs; oxygénation index (Ol)>25 ±/or pulmonary artery pressure (PAP)>1/2 systemic arterial pressure ±/or lung injury score >2.5. Use of ECMO in RF is considered for pts. with continued Ol >40 failing permissive hypercarbia, surfactant, high frequency ventilation or inhaled nitric oxide. Pts are given a trial of 10-80ppm INO for 10 minutes with Oppm intervals between doses. Pts. with a dec/ease in Ol or PAP or increase in oxygénation are continued on INO until improvement occurs or benefit is lost Results: Of 10 ECMO candidates, 5 improved with INO and did not receive ECMO. Survival was 4/5 in this group (non-ECMO pts). In 5/10 pts., INO trial effects failed to be maintained or were insufficient to avoid emergent ECMO. All 5 of these pts died (ECMO pts). Demographics and oxygénation data are presented below (Note: OI=Mean airway pressure xFiO2/paO2): Non-ECMO ECMO pts (N=5) (N=5) Age (yrs., range 0-26) 7.3 ± 11 3.2 ± 7 Days Int Prior to INO 2.5. ± 2 6.2 ±5 Dur INO (days) 4± 1 .2 ±.5 Baseline Ol/ 24 hr Ol 41 ± 6/24 ±15* 67± 30/-Base paO2/F(O2/24 hr pa02/FK>2 55 ± 14/108 ± 42* 43 ± 20/-*p<.05 vs. Baseline Conclusions: In non-ECMO pts treated with INO, significant improvement in Ol and paO2/FiO2 was evident by 24 hours. By 120 hrs, non-ECMO pts. were off INO and average Ol was 10. Use of INO in non-ECMO pts. was within 2 d of initiation of mechanical ventilation vs. 6.2 d in pts. failing INO who then received ECMO. We conclude that: 1. Early use of INO in RF may improve survival and preclude use of ECMO. 2. Delay in use of INO and ECMO >6-7 days in patients with severe RF failing other therapies Is associated with poor survival.