Clinical Effects of Nitric Oxide Added to the Oxygenator of Children on Extracorporeal Membrane Oxygenation: Pre-Post Cohort Study

Kevin C Pan; Siva P Namachivayam; Roberto Chiletti; Derek Best; Stephen Horton; Warwick Butt

doi:10.1097/MAT.0000000000002164

Clinical Effects of Nitric Oxide Added to the Oxygenator of Children on Extracorporeal Membrane Oxygenation: Pre-Post Cohort Study

ASAIO J. 2024 Feb 29. doi: 10.1097/MAT.0000000000002164. Online ahead of print.

Authors

Kevin C Pan^{1

2}, Siva P Namachivayam^{1

2

3

4}, Roberto Chiletti^{1

2

3}, Derek Best¹, Stephen Horton^{3

5}, Warwick Butt^{1

2

3

4}

Affiliations

¹ From the Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia.
² Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
³ Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
⁴ Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
⁵ Department of Perfusion, The Royal Children's Hospital, Melbourne, VIC, Australia.

PMID: 38417432
DOI: 10.1097/MAT.0000000000002164

Abstract

Nitric oxide (NO) can be safely delivered through the sweep gas to the oxygenator of an extracorporeal membrane oxygenation (ECMO) circuit. It has theoretical benefits such as preventing platelet adhesion to surfaces, mitigating inflammatory response and protection against ischemia-reperfusion injury. In this uncontrolled before-after study of children on ECMO, the outcomes of those who received NO were compared with those who did not. Among 393 ECMO runs (from 337 patients), 192 of 393 (49%) received NO and 201 of 393 (51%) did not. The use of NO was associated with a 37% reduction in circuit change (adjusted risk ratio [aRR]: 0.63, 95% confidence interval [CI]: 0.42-0.93). The aRR (95% CI) for risk of neurologic injury was 0.72 (0.47-1.11). We observed potential heterogeneity of treatment effect for the risk of neurologic injury in children who had cardiac surgery: the risk with NO was lower in those who had cardiac surgery (aRR: 0.50, 95% CI: 0.26-0.96). There was no difference in survival between the study groups. In children managed with NO delivered through the ECMO circuit, we report a reduction in observed rate of circuit change and lower risk of neurologic injury in children who underwent cardiac surgery. Nitric oxide therapy on ECMO warrants prospective evaluation in children.