When is ECMO indicated for a newborn with PPHN?

When is ECMO indicated for a newborn with PPHN?

• A. When OI >20
• B. When OI >40 And There Is No Response To iNO
• C. When OI >60
• D. When There Is Response To iNO

Answer: (B)

ECMO is considered a rescue option for newborns with PPHN when oxygenation remains severely impaired despite optimized conventional support, including inhaled nitric oxide. The oxygenation index (OI) reflects the level of hypoxemia relative to support; an OI above 40 signals significant oxygenation failure. If there is no improvement after maximizing therapy with inhaled nitric oxide, ECMO provides temporary cardiopulmonary support to allow the lungs to recover while maintaining oxygen delivery. While some centers use higher thresholds (such as an OI above 60) as a more urgent signal, the classic NBRC criterion is an OI greater than 40 with no response to iNO.

ECMO is considered a rescue option for newborns with PPHN when oxygenation remains severely impaired despite optimized conventional support, including inhaled nitric oxide. The oxygenation index (OI) reflects the level of hypoxemia relative to support; an OI above 40 signals significant oxygenation failure. If there is no improvement after maximizing therapy with inhaled nitric oxide, ECMO provides temporary cardiopulmonary support to allow the lungs to recover while maintaining oxygen delivery. While some centers use higher thresholds (such as an OI above 60) as a more urgent signal, the classic NBRC criterion is an OI greater than 40 with no response to iNO.