Úloha mimotělní membránové oxygenace v léčbě syndromu mekoniové aspirace

More experience is required with the assessment of recently developed therapeutic methods for neonates with respiratory failure. Meconium aspiration syndrome (MAS) remains the most frequent cause of severe neonatal respiratory failure. We reviewed the experience with extracorporeal membrane oxygenation (ECMO) in MAS in a centre specializing in ECMO treatment. Between August 1989 and October 1996, 126 neonates underwent ECMO for severe respiratory failure in one institution. Forty one of these (33 %) presented with MAS at a median age of 24 hours (range 5 - 168 hours). The duration of ECMO treatment ranged from 45 to 250 hours (median 87 hours). Forty patients (97.6 %) survived ECMO and were transferred to referring hospitals. In 1 case, ECMO treatment was terminated for severe ischaemic brain injury. Mortality in MAS treated with ECMO (2.4 %) compares favourably with overall mortality (34.5 %) of other neonates undergoing ECMO for respiratory failure. Patients with MAS were younger (41 ± 38 hours, mean ± SD) at the time of referral and their course on ECMO shorter (93 ± 40 hours) than in the remaining neonates (86 ± 105 hours, p = 0,0008, and 158 ± 118 hours, p < 0.0001, respectively). The 10 patients with MAS who required venoarterial ECMO due to concomitant cardiac failure did not differ from the remaining 31 neonates undergoing venovenous ECMO as to their age, weight, and oxygenation index at presentation nor as to the period on ECMO (86 ± 29 hours v. 96 ± 43 hours, p = 0.43). We conclude that ECMO is a safe alternative to other methods of treatment in neonates with severe MAS. Early referral for ECMO in patients with MAS who do not respond favourably to conventional treatment is desirable.