**5. Short- and long-term outcomes in asphyxiated newborns treated with hypothermia and ECMO**

Hypothermia treatment has improved the prognosis of asphyxiated newborns, making neonatal encephalopathy a "reversible" condition in one of seven treated newborns [37, 38]. However, due to their risk of irreversible brain injury, clinicians often are concerned about offering ECMO to these newborns [39]. Data on the outcome of asphyxiated newborns who received ECMO during the first 72 h of life are scarce [9–11] (**Table 1**). Shah et al. [11] reported on two asphyxiated newborns treated with hypothermia and ECMO who survived, but they did not mention their outcome. Massaro et al. [9] reported on five asphyxiated newborns treated with hypothermia and ECMO: they all survived and three of them were developmentally age appropriate at follow-up at 6–21 months; one had increased tone at 3 months but then was lost to follow up; and one had significant motor and cognitive delay. Cuevas Guaman et al. [10] studied 78 asphyxiated newborns treated with hypothermia and ECMO and reported a 15% mortality, 22% neurological complications (e.g., brain hemorrhage or infarction), and 12% seizure rate; however, they did not report on the long-term outcomes of these newborns. Thus, current evidence suggests that the outcome of asphyxiated newborns treated with hypothermia and ECMO is not always poor.

In addition, to achieve optimal results, early rather than later consideration of ECMO during the course of therapeutic hypothermia is probably important for these critically ill newborns,


If started in an optimal timeframe, ECMO associated with hypothermia treatment may ensure adequate oxygenation, treat catecholamines-resistant hypotension, and minimize further brain injury in these newborns, without causing intracerebral hemorrhage if coagulopathy

Extracorporeal Membrane Oxygenation Use in Asphyxiated Newborns…

http://dx.doi.org/10.5772/intechopen.78761

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In conclusion, ECMO might thus be considered as a therapeutic option for asphyxiated newborns treated with hypothermia, if they need it respiratory or hemodynamic support, if they

We thank Mr. Wayne Ross Egers for his professional English correction of the manuscript.

The authors declare no competing financial interests. No honorarium, grant, or other form of

Pia Wintermark receives research grant funding from the FRSQ Clinical Research Scholar

and Pia Wintermark3

1 Division of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Canada

2 Division of Pediatric Intensive Care Unit, Department of Pediatrics, Montreal Children's

3 Division of Newborn Medicine, Department of Pediatrics, Montreal Children's Hospital,

\*

have no proven irreversible brain injury visible at the time of starting ECMO.

payment was received for the preparation of this manuscript.

Career Award Junior 2 and a CIHR Operating Grant.

, Samara Zavalkoff2

\*Address all correspondence to: pia.wintermark@bluemail.ch

can be kept under control.

**Acknowledgements**

**Conflict of interest**

**Funding**

**Author details**

Asim Al Balushi1

Montreal, Canada

Hospital, Montreal, Canada

**7. Conclusions**

**Table 1.** Outcomes in asphyxiated newborns treated with hypothermia and extracorporeal membrane oxygenation (ECMO).

since a prolonged duration of metabolic acidosis, inotropic support, and a need for inhaled nitric oxide prior to ECMO initiation have been associated with a higher rate of bleeding complications [40, 41], and since hemodynamic instability has been associated with worsened brain injury in those newborns [16]. In addition, it may be safer to start ECMO, if required, before the rewarming phase following the 72-h hypothermia treatment, so to allow hemodynamic support during this time-period when pulmonary hypertension crises are more likely to occur [11].
