Changes in buccal microcirculation following extracorporeal membrane oxygenation in term neonates with severe respiratory failure

Objectives: Extracorporeal membrane oxygenation (ECMO) is known to improve cardiorespiratory function and outcome in neonates with severe respiratory failure. In this study, we tested two hypotheses: 1) neonates with severe respiratory failure exhibit alterations of the microcirculation and 2) after ECMO therapy these microcirculatory alterations are improved. Design: Single-center prospective observational study. Setting: Intensive care unit of a level III university children's hospital. Patients: Term neonates receiving venoarterial ECMO. Control patients with and without respiratory failure. Measurements and Main Results: The microcirculation was assessed in the buccal mucosa, using orthogonal polarization spectral imaging, before and after ECMO. Functional capillary density was lower in patients with severe respiratory failure before ECMO (n = 14) compared with control patients (n = 10; p < 0.01). Functional capillary density had increased significantly after ECMO (p < 0.01). Conclusion: Microcirculatory parameters are depressed in neonates with severe respiratory failure and improve significantly following ECMO treatment. (Crit Care Med 2009; 37:1121-1124)