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Efficacy and economy of inhaled nitric oxide in neonates accepted for extra-corporeal membrane oxygenation.

OBJECTIVE
To study the clinical efficacy as well as the cost-effectiveness of inhaled nitric oxide (NO) compared with extra-corporeal membrane oxygenation (ECMO) in neonates with pulmonary hypertension and hypoxic respiratory failure accepted for ECMO treatment.


DESIGN
Retrospective study of the first 10 consecutive neonatal patients treated with inhaled NO during 1992-94. Inhaled NO was administered after failure of conventional treatment as a last resort before initiating ECMO. For cost-effectiveness calculations the above-described patient population was compared with ECMO patients having a very favourable ECMO course.


SETTING
Twelve-bed neonatal and paediatric intensive care unit with ECMO capabilities at a tertiary university referral hospital.


RESULTS
Inhaled NO was found to significantly decrease the oxygenation index (OI pre-NO: median 80.5; OI post-NO: median 22.5; P=0.003) and five of the patients could successfully be handled without the use of ECMO. ECMO was found to be more than four times as expensive as inhaled NO treatment on a per hour basis ($244 vs. $53 per hour) and the net savings from being able to avoid ECMO in five patients was calculated to be $156 200.


CONCLUSION
Initiation of inhaled NO caused a significant improvement in oxygenation index and reduced the need for ECMO by 50% in critically ill neonatal patients with hypoxic respiratory failure. Inhaled NO was also found to compare very favourably with ECMO regarding cost-effectiveness ($53 vs. $244 per treatment hour).