Recurrent pulmonary arterial hypertension following neonatal treatment with extracorporeal membrane oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) provides pulmonary and cardiac support to neonates with life-threatening persistent pulmonary arterial hypertension unresponsive to other therapies (1, 2). After ECMO treatment, ≥80% of patients with persistent pulmonary arterial hypertension survive (3) and are frequently weaned from mechanical ventilation within a few days (4). Treatment of persistent pulmonary arterial hypertension with ECMO assumes that a) pulmonary arterial hypertension will improve over several days after correcting hypoxemia and reducing mean airway pressure (5); and b) after improvement, pulmonary arterial hypertension will not recur. However, in some infants, especially those patients with congenital diaphragmatic hernia, persistent pulmonary arterial hypertension and lung function do not improve despite ECMO therapy (6). These nonresponders account for many of the approximately 20% of all ECMO patients who do not survive (3, 6). Pulmonary artery pressures and echocardiographic findings after ECMO are not well studied, and the return of severe pulmonary arterial hypertension following apparently successful ECMO has not been described. We report life-threatening, recurrent pulmonary arterial hypertension after apparently successful ECMO therapy in three patients, two of whom survived without repeat courses of ECMO therapy.