Pushing the Boundaries of ECLS: Outcomes in < 34 week EGA Neonates

Abstract Purpose Extracorporeal life support (ECLS) is usually reserved for infants ≥ 34 weeks estimated gestational age (EGA) due to concerns about increased mortality and incidence of intracranial hemorrhage (ICH). We sought to characterize survival, rates of ICH, and complications in < 34 week EGA neonates placed on ECLS. Methods 752 neonates of EGA 29–34 weeks were identified in the Extracorporeal Life Support Organization (ELSO) Registry (1976–2008). Data analyzed included birthweight, survival, pre-ECLS conditions, ventilatory parameters and complications (including ICH and other neurological outcomes). Data were compared using t-test, Chi-square and logistic regression analyses. Results When compared to survival rates of 34 week EGA neonates (58%), survival was statistically different for 29–33 week EGA (48%, p = 0.05). No significant difference in ICH incidence was seen between the 29–33 week and 34 week groups (21% vs. 17%, respectively), but a significant difference was seen in the incidence of cerebral infarct between groups (22% for 29–33 weeks vs. 16% for 34 weeks; p = 0.03). ICH and survival did not correlate with EGA during logistic regression analysis. Conclusions Though rates of survival and cerebral infarction were worse at 29–33 weeks EGA compared with 34 weeks, these differences were modest and may be clinically acceptable. This suggests that EGA < 34 weeks may not be an absolute contraindication to use of ECLS. Level of Evidence III.