Document Detail


Comparison of six ECMO selection criteria and analysis of factors influencing their accuracy.
MedLine Citation:
PMID:  1758744     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This study compared six extracorporeal membrane oxygenation (ECMO) selection criteria in 42 neonates and analyzed factors influencing the accuracy of outcome predictions. The sensitivity of the criteria in identifying fatal cases varied from 0.44 to 0.94 and the specificity of predictions of survival ranged from 0.42 to 0.69. The criterion having the highest sensitivity had the lowest specificity and conversely the criterion with the lowest sensitivity had the highest specificity. Overall accuracy of the criteria, as measured by the total number of correct outcome predictions, differed little among the criteria (23/42 to 27/42 correct predictions). Three factors influenced predictive accuracy: 1) a primary diagnosis of congenital diaphragmatic hernia (CDH) was associated with a greater mortality (P less than 0.001) and a significantly higher positive predictive value (PPV) for all criteria (P = 0.0009-0.012) than that seen in patients with other primary diagnoses; 2) calculating the alveolar-arterial oxygen gradient using an assumed, rather than measured barometric pressure, or estimating oxygenation index using a calculated, rather than a measured, mean airway pressure, increased false positive mortality predictions in non-CDH patients; and 3) requiring a peak inspiratory pressure (PIP) of at least 50 cm H2O in the definition of maximal medical management, rather than a PIP of 20-49 cm H2O, significantly increased the PPV for three of four criteria examined (P = 0.02-0.04). Awareness of these factors may facilitate the identification of neonates who need ECMO to survive.
Authors:
N R Payne; P Kriesmer; M Mammel; C L Meyer
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Pediatric pulmonology     Volume:  11     ISSN:  8755-6863     ISO Abbreviation:  Pediatr. Pulmonol.     Publication Date:  1991  
Date Detail:
Created Date:  1992-02-06     Completed Date:  1992-02-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  223-32     Citation Subset:  IM    
Affiliation:
Department of Neonatology, Minneapolis Children's Medical Center, MN 55404.
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MeSH Terms
Descriptor/Qualifier:
Extracorporeal Membrane Oxygenation* / contraindications
Hernia, Diaphragmatic / congenital*,  mortality,  therapy
Humans
Hyaline Membrane Disease / mortality,  therapy*
Infant, Newborn
Meconium Aspiration Syndrome / mortality,  therapy*
Prognosis
Pulmonary Gas Exchange / physiology
Risk Factors
Sensitivity and Specificity
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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