Inflight use of extracorporeal membrane oxygenation for severe neonatal respiratory failure

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Abstract
Extracorporeal membrane oxygenation (ECMO) is a heart-lung bypass technique which has been used over the past ten years to support some 300 neonates with life-threatening respiratory failure. It is estimated that, within the constraints of currently accepted treatment criteria, there are between 2,000 and 3,000 neonates born each year within the United States who require this extreme therapeutic measure. Unfortunately, since there are still relatively few medical centres in the country offering this type of support, it is frequently necessary to transport candidate neonates from the hospital of birth to a referral centre. This is generally a tenuous procedure since neonates who are sufficiently ill to require ECMO treatment are commonly poor transport risks. We report the first successful use of an ECMO system designed to be transported to the referring hospital, assembled, and used to support an infant on bypass for a controlled air transport back to the receiving medical centre. The potential for decreasing the morbidity and mortality of selected infants requiring ECMO support by the addition of this capability is discussed.