**Funding**

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].

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

2/2 (100%) survived

5/5 (100%) survived

66/78 (85%) survived

known

known

Long-term neurodevelopmental outcome not

• 3/5 (60%) developmentally age appropriate at

• 1/5 (20%) increased tone at 3 months but then

• 1/5 (20%) significant motor and cognitive delay

Long-term neurodevelopmental outcome not

• 17/78 (22%) neurological complications (e.g., brain hemorrhage or infarction)

follow-up at 6–21 months;

was lost to follow up;

Short-term outcome included:

• 9/78 (12%) seizure rate

**Reference Number of newborns Survival rate Outcomes**

treated with hypothermia and

treated with hypothermia and

Seventy-eight asphyxiated newborns treated with hypothermia and ECMO

Shah et al. [11] Two asphyxiated newborns

70 Advances in Extra-corporeal Perfusion Therapies

ECMO

ECMO

Cuevas Guaman et al. [10]

(ECMO).

Massaro et al. [9] Five asphyxiated newborns

**6. Considerations for using ECMO in asphyxiated newborns treated** 

ECMO is an expensive and labor-intensive, life-sustaining modality. The ideal candidate for ECMO is a patient with a reversible disease condition for whom standard treatments have failed to reverse the disease process and for whom mortality risk is high. The most common contraindications for neonatal ECMO currently include a gestational age less than 34 weeks, weight of less than 2 kg, significant coagulopathy, significant intraventricular hemorrhage, and an underlying genetic condition with a poor prognosis [42]. Severe metabolic acidosis prior to ECMO also is considered a relative contraindication for ECMO, since this has been associated previously with higher mortality and brain injury [43]. However, the successful use of ECMO has been reported for a newborn with persistent pulmonary hypertension, presumed sepsis, and a pre-ECMO pH of less than 6.6 [44]. Thus, asphyxiated newborns treated with hypothermia—if they do not present with intraventricular hemorrhage or proven severe and irreversible brain injury at the time of cannulation—should be eligible for ECMO.

**with hypothermia**

Pia Wintermark receives research grant funding from the FRSQ Clinical Research Scholar Career Award Junior 2 and a CIHR Operating Grant.
