Serial Measurement of Pulmonary Mechanics Assists in Weaning From Extracorporeal Membrane Oxygenation in Neonates with Respiratory Failure

Extracorporeal membrane oxygenation (ECMO) is a highly invasive therapy for intractable neonatal respiratory failure, and serious complications may occur with increasing duration of bypass. Weaning from bypass is empirical at present. Thus, there is a need to accurately predict when infants can be successfully decannulated. We hypothesized that pulmonary mechanics would reflect lung recovery and, therefore, predict successful weaning from ECMO. We measured pulmonary mechanics daily in 22 neonates, at gestational age of 37.8±0.6 weeks (SE) requiring ECMO for severe respiratory failure (oxygen index 66±6). Pulmonary resistance (Rpul), dynamic compliance (Cdyn), and tidal volume (vt) were measured. Rpul did not predict lung recovery. Cdyn within 24 hours of starting ECMO was 0.3 ±0.04 ml/cm H2O. Cdyn within 24 hours of weaning from ECMO was 1.2±0.09 ml/cm H2O (p