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Neonatal pulmonary hypertension during extracorporeal membrane oxygenation

Published online by Cambridge University Press:  19 August 2008

Ronald B. Tanke ,
Otto Daniëls ,
Henk J. van Lier ,
Arno F. van Heyst  and
Cees Festen
Ronald B. Tanke*
Affiliation:
Children's Heart Center, University Hospital Nijmegen, The Netherlands
Otto Daniëls
Affiliation:
Children's Heart Center, University Hospital Nijmegen, The Netherlands
Henk J. van Lier
Affiliation:
Department of Medical Statistics, University Hospital Nijmegen, The Netherlands
Arno F. van Heyst
Affiliation:
Department of Neonatology, University Hospital Nijmegen, The Netherlands
Cees Festen
Affiliation:
Departrnent of Paediatric Surgey, University Hospital Nijmegen, The Netherlands
*
Ronald B Tanke, MD, University Hospital Nijmegen, Children's Heart Centre, Geert Grooteplein 10, PO Box 9101, 6500 HB Nijmegen, The Netherlands Tel: +31 24 361 66 91, Fax +31 24 361 90 52, E-mail r.tanke@ckskhc.azn.nl
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Abstract

Objectives

This prospective study was designed to monitor severe pulmonary hypertension during extra corporeal membrane oxygenation using echo Doppler variables.

Background

All neonates treated with extracorporeal membrane oxygenation also have severe pulmonary hypertension. A study which monitors the reaction of the pre-existing pulmonary hypertension during extracorporeal oxygenation by frequent sampling of those variables related to pulmonary pressure is still lacking. Such a study is necessary to analyze the complex haemodynamic changes in patients undergoing extracorporeal membrane oxygenation.

Method

In 29 neonates, we estimated pulmonary arterial pressure using peakflow velocity of regurgitation across the tricuspid- and pulmonary valve, peakflow velocity of shunting across persistent arterial ductus, and systolic time intervals of the right ventricle. Correlation between the several estimations of pulmonary arterial pressure were analysed with the Spearman correlation coefficient.

Results

Systolic pulmonary arterial pressure measured by the velocity of tricuspid regurgitation illustrated severe pulmonary hypertension prior to extra corporeal membrane oxygenation (mean 63 mmHg, sd 20). Similar levels for the systolic pulmonary arterial pressure could be derived (mean 73 mmHg, sd 17) from ductal shunting. A fair correlation of 0.76 (p< 0.002) could be demonstrated. Pulmonary hypertension responded well and quickly to treatment by extra corporeal membrane oxygenation, with reductions within 24 hours to mean systolic levels of 35 mmHg, sd 23. This very early reaction has not previously been demonstrated and could be of importance in defining parameters for weaning from cardiopulmonary bypass. Diastolic pulmonary arterial pressure was investigated because of its relation to vascular resistance. It proved more difficult to measure because of the low incidence of pulmonary regurgitation. Derived diastolic pressures did not show any good correlations.

Conclusion

Pulmonary hypertension is well documentated prior to extra corporeal membrane oxygenation and respons very quickly to the institution of treatment. Ultra sound techniques are indicated at the bedsite, and prove useful in monitoring pulmonary blood pressure during the procedure.

Keywords

extra corporeal membrane oxygenationpulmonary hypertensionneonates
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 2 , March 2000 , pp. 130 - 139
Copyright
Copyright © Cambridge University Press 2000

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