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Important Notice for Contributors to The Annals of Thoracic Surgery
535
Weber, Pennington, Connors, et al: Extracorporeal Membrane Oxygenation for Newborns
has addressed the problem of selection of patients in several prospective randomized studies, and has tried to determine more precisely when the babies should be placed on the apparatus and which babies are the best candidates for the procedure. He and others are continuing these studies at present. In answer to your question concerning hypothermia, we have not utilized that approach as yet, although it does seem attractive. I am also unaware of any other ECMO program for newborns that uses hypothermia at this time. As for the ventilator settings, we decreased the rate to 10 per minute, the peak ventilator pressure to 15 cm H 2 0 , and the inspired O2 fraction to 0.3. We don’t completely eliminate the ventilator, but rather utilize very low settings until the lungs have recovered. This generally results in opacification of the lung fields on roentgenograms for several days, but when the
roentgenogram begins improving, that is usually a signal that the baby is ready for weaning from ECMO. As for the age and weight of the patient, we have not noticed any difference in survival in regard to the patient’s weight. Bob Bartlett has noticed that the much smaller babies, with weights in the range of 1,200 to 1,400 gm, don’t seem to tolerate the procedure well and have a high incidence of intracerebral bleeding. However, to date, we have not treated any babies that small. Finally, the lesions that seem to respond best to ECMO include meconium aspiration and persistent fetal circulation. The highest mortality to date seems to be in babies with diaphragmatic hernia and severe pulmonary hypoplasia. We will continue to look for improvements in the technique that might offer survival to an increasingly large group of babies.
Important Notice for Contributors to The Annals of Thoracic Surgery Beginning with this issue, The Annals is instituting several changes in the processing of manuscripts. The most important of these are: (1) One original and two duplicate manuscripts will be required, including three separated and clearly labeled sets of illustrations. Formerly, only the original and one duplicate manuscript and two sets of illustrations were required. (2) Because of escalating postage costs, manuscripts and
illustrations routinely will not be returned to the authors. The Editorial Office will be responsible for their proper disposal so that confidentiality is preserved. Manuscripts and illustrations will be returned only if requested and a self-addressed stamped (US postage) envelope provided. There are also a number of other changes. We urge prospective contributors to read the Information for Authors sheet carefully before submitting manuscripts.
Weber, Pennington, Connors, et al: Extracorporeal Membrane Oxygenation for Newborns
has addressed the problem of selection of patients in several prospective randomized studies, and has tried to determine more precisely when the babies should be placed on the apparatus and which babies are the best candidates for the procedure. He and others are continuing these studies at present. In answer to your question concerning hypothermia, we have not utilized that approach as yet, although it does seem attractive. I am also unaware of any other ECMO program for newborns that uses hypothermia at this time. As for the ventilator settings, we decreased the rate to 10 per minute, the peak ventilator pressure to 15 cm H 2 0 , and the inspired O2 fraction to 0.3. We don’t completely eliminate the ventilator, but rather utilize very low settings until the lungs have recovered. This generally results in opacification of the lung fields on roentgenograms for several days, but when the
roentgenogram begins improving, that is usually a signal that the baby is ready for weaning from ECMO. As for the age and weight of the patient, we have not noticed any difference in survival in regard to the patient’s weight. Bob Bartlett has noticed that the much smaller babies, with weights in the range of 1,200 to 1,400 gm, don’t seem to tolerate the procedure well and have a high incidence of intracerebral bleeding. However, to date, we have not treated any babies that small. Finally, the lesions that seem to respond best to ECMO include meconium aspiration and persistent fetal circulation. The highest mortality to date seems to be in babies with diaphragmatic hernia and severe pulmonary hypoplasia. We will continue to look for improvements in the technique that might offer survival to an increasingly large group of babies.
Important Notice for Contributors to The Annals of Thoracic Surgery Beginning with this issue, The Annals is instituting several changes in the processing of manuscripts. The most important of these are: (1) One original and two duplicate manuscripts will be required, including three separated and clearly labeled sets of illustrations. Formerly, only the original and one duplicate manuscript and two sets of illustrations were required. (2) Because of escalating postage costs, manuscripts and
illustrations routinely will not be returned to the authors. The Editorial Office will be responsible for their proper disposal so that confidentiality is preserved. Manuscripts and illustrations will be returned only if requested and a self-addressed stamped (US postage) envelope provided. There are also a number of other changes. We urge prospective contributors to read the Information for Authors sheet carefully before submitting manuscripts.