The “Hub and Spoke” (HandS) ECMO for “Resuscitating” Neonates with Respiratory Life-Threatening Conditions

Massimo A. Padalino; Nicoletta Doglioni; Daniel Nardo; Eugenio Baraldi; Vladimiro L. Vida; Daniele Trevisanuto

doi:10.3390/children8010024

Children (Jan 2021)

The “Hub and Spoke” (HandS) ECMO for “Resuscitating” Neonates with Respiratory Life-Threatening Conditions

Massimo A. Padalino,
Nicoletta Doglioni,
Daniel Nardo,
Eugenio Baraldi,
Vladimiro L. Vida,
Daniele Trevisanuto

Affiliations

Massimo A. Padalino: Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy
Nicoletta Doglioni: Neonatal Intensive Care Unit, Department of Woman’s and Child’s Health, University of Padova, 35122 Padova, Italy
Daniel Nardo: Neonatal Intensive Care Unit, Department of Woman’s and Child’s Health, University of Padova, 35122 Padova, Italy
Eugenio Baraldi: Neonatal Intensive Care Unit, Department of Woman’s and Child’s Health, University of Padova, 35122 Padova, Italy
Vladimiro L. Vida: Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy
Daniele Trevisanuto: Neonatal Intensive Care Unit, Department of Woman’s and Child’s Health, University of Padova, 35122 Padova, Italy

DOI: https://doi.org/10.3390/children8010024
Journal volume & issue: Vol. 8, no. 1
p. 24

Abstract

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Background: Extracorporeal membrane oxygenation (ECMO) implantation for neonates with severe cardiorespiratory life-threatening conditions is highly effective. However, since ECMO is a high-risk and complex therapy, this treatment is usually performed in centers with proven expertise. Methods: A retrospective review of neonates, from January 2014 to January 2020, presenting with life-threatening conditions and treated by means of Hub and Spoke (HandS) ECMO in peripheral (spoke) hospitals. Data were retrieved from our internal ECMO registry. Protocols and checklists were revised and shared with all spoke hospitals located in North-Eastern Italy. Results: Eleven neonates receiving maximal respiratory and cardiovascular support at a spoke hospital underwent HandS ECMO management. All but three patients were affected by life-threatening meconium aspiration syndrome (MAS). The median ECMO support duration and hospitalization were four (range 2–32) and 30 days (range 8–50), respectively. All but two patients (with congenital diaphragmatic hernia), were weaned off ECMO and discharged home. At a mean follow up of 33.7 ± 29.2 months, all survivors were alive and well, without medications, and normal somatic growth. All but one had normal neuropsychological development. Conclusion: HandS ECMO model for neonates with life-threatening conditions is effective and successful. A specialized multidisciplinary team and close cooperation between Hub and Spoke centers are essential for success.

Published in Children

ISSN: 2227-9067 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine: Pediatrics
Website: http://www.mdpi.com/journal/children

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