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H and S ECMO : Preliminary Experience With “Hub and Spoke” Model in Neonates With Meconium Aspiration Syndrome
Author(s) -
Fichera Dario,
Zanella Fabio,
Fabozzo Assunta,
Doglioni Nicoletta,
Trevisanuto Daniele,
Lolli Elisabetta,
Vida Vladimiro,
Ceccherini Enrico,
Ebraico Agostino,
Stellin Giovanni,
Padalino Massimo
Publication year - 2019
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.13270
Subject(s) - medicine , extracorporeal membrane oxygenation , meconium aspiration syndrome , meconium , life support , intubation , surgery , extracorporeal , multidisciplinary team , anesthesia , pregnancy , intensive care medicine , fetus , nursing , biology , genetics
We aim to evaluate clinical outcomes of emergent extracorporeal membrane oxygenation (ECMO) implantation in newborns with life‐threatening meconium aspiration syndrome (MAS) in peripheral hospitals with Hub and Spoke (HandS) setting. We retrospectively reviewed all neonates presenting with MAS, with no other comorbidities, treated with HandS ECMO, in peripheral hospitals. Team activation time (TAT) was described as the time from first alerting call to ECMO support initiation. From May 2014 to December 2016, 4 patients met our inclusion criteria. In addition, 2 cases occurred on the same day, requiring a second simultaneous HandS ECMO team activation. All patients were younger than 8 days of life (1, 1, 4, and 7), with a mean BSA 0.21 ± 0.03m 2 , and TAT of 203, 265, 320, and 340 min. One patient presented ventricular fibrillation after priming administration. Veno‐arterial ECMO was established in all patients after uneventful surgical neck vessels cannulation (right carotid artery and jugular vein). Mean time from skin incision to ECMO initiation was 19 ± 1.4 min. Mean length of ECMO support was 2.75 ± 1.3 days. All patients were weaned off support without complications. At a mean follow up of 20.5 ± 7.8 months, all patients are alive, with no medications, normal somatic growth, and neuropsychological development. MAS is a life‐threatening condition that can be successfully managed with ECMO support. A highly trained multidisciplinary HandS ECMO team is crucial for the successful management of these severely ill newborns in peripheral hospitals.