Diagnosis-related deterioration of lung function after extracorporeal membrane oxygenation

Abstract

To assess lung function longitudinally after neonatal ECMO, and to identify any effects of diagnosis and perinatal characteristics.

121 neonatal ECMO-treated children (70 meconium aspiration syndrome, 20 congenital diaphragmatic hernia, 31 other diagnoses) performed altogether 191 lung function measurements at 5, 8 and/or 12 years. We assessed dynamic and static lung volumes, reversibility of airway obstruction and diffusion capacity.

Mean SDS FEV1 at 5 years before and after bronchodilation (−0.51 and 0.07) was significantly higher than at 8 (−0.79 and −0.4, p<0.04) and 12 years (−1.10 and −0.52, p<0.003). Mean SDS for all spirometric parameters before and after bronchodilation were significantly lower in the congenital diaphragmatic hernia group compared the other diagnostic groups (all p≤0.025). A significant volume of trapped air was observed in 86% patients with congenital diaphragmatic hernia, 50% with meconium aspiration syndrome and 58% with other diagnoses. After bronchodilation mean SDS FEV1 and FVC were negatively influenced by duration of ventilation (both p<0.001) and duration of ECMO (p=0.003 and p=0.02 respectively).

Long-term pulmonary sequelae after neonatal ECMO-treatment mainly occur in congenital diaphragmatic hernia patients and tend to deteriorate over time.