{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:50:52Z","timestamp":1790632252280,"version":"4.1.0"},"reference-count":37,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T00:00:00Z","timestamp":1609804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Extracorporeal membrane oxygenation (ECMO) implantation for neonates with severe cardiorespiratory life-threatening conditions is highly effective. However, since ECMO is a high-risk and complex therapy, this treatment is usually performed in centers with proven expertise. Methods: A retrospective review of neonates, from January 2014 to January 2020, presenting with life-threatening conditions and treated by means of Hub and Spoke (HandS) ECMO in peripheral (spoke) hospitals. Data were retrieved from our internal ECMO registry. Protocols and checklists were revised and shared with all spoke hospitals located in North-Eastern Italy. Results: Eleven neonates receiving maximal respiratory and cardiovascular support at a spoke hospital underwent HandS ECMO management. All but three patients were affected by life-threatening meconium aspiration syndrome (MAS). The median ECMO support duration and hospitalization were four (range 2\u201332) and 30 days (range 8\u201350), respectively. All but two patients (with congenital diaphragmatic hernia), were weaned off ECMO and discharged home. At a mean follow up of 33.7 \u00b1 29.2 months, all survivors were alive and well, without medications, and normal somatic growth. All but one had normal neuropsychological development. Conclusion: HandS ECMO model for neonates with life-threatening conditions is effective and successful. A specialized multidisciplinary team and close cooperation between Hub and Spoke centers are essential for success.<\/jats:p>","DOI":"10.3390\/children8010024","type":"journal-article","created":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T10:35:12Z","timestamp":1609842912000},"page":"24","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The \u201cHub and Spoke\u201d (HandS) ECMO for \u201cResuscitating\u201d Neonates with Respiratory Life-Threatening Conditions"],"prefix":"10.3390","volume":"8","author":[{"given":"Massimo A.","family":"Padalino","sequence":"first","affiliation":[{"name":"Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoletta","family":"Doglioni","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Department of Woman\u2019s and Child\u2019s Health, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Nardo","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Department of Woman\u2019s and Child\u2019s Health, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenio","family":"Baraldi","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Department of Woman\u2019s and Child\u2019s Health, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1829-0259","authenticated-orcid":false,"given":"Vladimiro L.","family":"Vida","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6462-0079","authenticated-orcid":false,"given":"Daniele","family":"Trevisanuto","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, Department of Woman\u2019s and Child\u2019s Health, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1164\/rccm.201404-0630CP","article-title":"Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients","volume":"190","author":"Combes","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/j.jtcvs.2012.11.037","article-title":"Increased extra- corporeal membrane oxygenation center case volume is associated with improved extracorporeal membrane oxygenation survival among pediatric patients","volume":"145","author":"Karamlou","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1097\/01.ccm.0000435674.83682.96","article-title":"Pediatric and neonatal extracorporeal membrane oxygenation: Does center volume impact mortality?","volume":"42","author":"Freeman","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1164\/rccm.201409-1634OC","article-title":"Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the Extracorporeal Life Support Organization registry","volume":"191","author":"Barbaro","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/MAT.0b013e3182238b55","article-title":"Safe transport of critically ill adult patients on extracorporeal membrane oxygenation support to a regional extracorporeal membrane oxygenation center","volume":"57","author":"Javidfar","year":"2011","journal-title":"ASAIO J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.amjsurg.2013.01.025","article-title":"Adult refractory hypoxemic acute respiratory distress syndrome treated with extracorporeal membrane oxygenation: The role of a regional referral center","volume":"205","author":"Michaels","year":"2013","journal-title":"Am. J. Surg."},{"key":"ref_7","unstructured":"Guidelines for ECMO Transport (2020, December 20). Ann Arbor, MI, Extracorporeal Life Support Organization (ELSO). Available online: https:\/\/www.elso.org\/Portals\/0\/Files\/ELSOGUIDELINESFORECMOTRANSPORT2015\u20132018."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1186\/s13054-015-0994-6","article-title":"The Stockholm experience: Interhospital transports on extracorporeal membrane oxygenation","volume":"19","author":"Broman","year":"2015","journal-title":"Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2012\/965159","article-title":"Respiratory Support in Meconium Aspiration Syndrome: A Practical Guide","volume":"2012","author":"Dargaville","year":"2012","journal-title":"Int. J. Pediatrics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1542\/peds.95.3.400","article-title":"Predictors of failure of high-frequency oscillatory ventilation in term infants with severe respiratory failure","volume":"95","author":"Paranka","year":"1995","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1038\/jp.2008.241","article-title":"Meconium aspiration syndrome remains a significant problem in the NICU: Outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period","volume":"29","author":"Singh","year":"2009","journal-title":"J. Perinatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3389\/fped.2016.00063","article-title":"Transportation of critically ill patients on extracorporeal membrane oxygenation","volume":"4","author":"Broman","year":"2016","journal-title":"Front. Pediatrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1038\/jp.2008.152","article-title":"Extracorporeal membrane oxygenation: Use in meconium aspiration syndrome","volume":"28","author":"Short","year":"2008","journal-title":"J. Perinatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/aor.13270","article-title":"HandS ECMO: Preliminary Experience with \u201cHub and Spoke\u201d Model in Neonates with Meconium Aspiration Syndrome","volume":"43","author":"Fichera","year":"2019","journal-title":"Artif. Organs"},{"key":"ref_15","unstructured":"Frankenburg, W.K., Dodds, J., Archer, P., Shapiro, H., and Bresnick, B. (1990). The Denver II: Technical Manual, Denver Developmental Materials."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/MAT.0000000000000475","article-title":"Extracorporeal Life Support Organization Registry International Report","volume":"63","author":"Thiagarajan","year":"2017","journal-title":"ASAJO J."},{"key":"ref_17","first-page":"590","article-title":"The \u201cbasic\u201d approach: A single-centre experience with a cost-reducing model for paediatric cardiac extracorporeal membrane oxygenation","volume":"24","author":"Padalino","year":"2017","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jtcvs.2011.12.065","article-title":"Extracorporeal membrane oxygenation: The simplified weaning bridge","volume":"143","author":"Vida","year":"2012","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1001\/jama.2011.1471","article-title":"Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1)","volume":"306","author":"Noah","year":"2011","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/j.healun.2010.11.018","article-title":"A traveling team concept to expedite the transfer and management of unstable patients in cardiopulmonary shock","volume":"30","author":"Jaroszewski","year":"2011","journal-title":"J. Heart Lung Transpl."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1016\/j.athoracsur.2014.06.025","article-title":"Two decades\u2019experience with interfacility transport on extracorporeal membrane oxygenation","volume":"98","author":"Bryner","year":"2014","journal-title":"Ann. Thor. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jpedsurg.2007.09.021","article-title":"A 22 year experience in global extracorporeal membrane oxygenation","volume":"43","author":"Coppola","year":"2008","journal-title":"J. Pediatrics Surg."},{"key":"ref_23","unstructured":"Extracorporeal Life Support Organization (2017, December 10). ELSO Neonatal Respiratory Failure Supplement to the ELSO General Guidelines. Version 1.4. Available online: http:\/\/www.elso.org."},{"key":"ref_24","unstructured":"(2017, September 04). ECMOnet, Censimento delle Terapie Intensive Italiane. Available online: http:\/\/www.ecmonet.org\/index.php?pag=cartina&id_sezione=68&id_supersezione=65."},{"key":"ref_25","first-page":"262","article-title":"Mobile ECMO team for inter-hospital transportation of patients with ARDS: A retrospective case series","volume":"6","author":"Lucchini","year":"2014","journal-title":"Heart Lung Vessel"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1177\/0267659118766829","article-title":"The first five years of neonatal and pediatric transports on extracorporeal membrane oxygenation in the center and south of Italy: The pediatric branch of the Italian \u201cRete Respira\u201d network","volume":"33","author":"Nardo","year":"2018","journal-title":"Perfusion"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1007\/s00134-011-2158-8","article-title":"Retrieval of critically ill adults using extracorporeal membrane oxygenation: An Australian experience","volume":"37","author":"Forrest","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1093\/icvts\/ivs215","article-title":"The French airbridge for circulatory support in the Carribean","volume":"15","author":"Lebreton","year":"2012","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1007\/s00134-011-2301-6","article-title":"The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: Preparation for severe respiratory emergency outbreaks","volume":"37","author":"Patroniti","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1056\/NEJMoa1214103","article-title":"PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome","volume":"368","author":"Guerin","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1177\/0267659114540020","article-title":"Experience with the Avalon\u00ae bicaval double-lumen veno-venous cannula for neonatal respiratory ECMO","volume":"30","author":"Speggiorin","year":"2015","journal-title":"Perfusion"},{"key":"ref_32","unstructured":"(2020, July 04). ELSO Registry Report. Available online: www.elso.org."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1002\/bjs5.50135","article-title":"One-year outcomes for congenital diaphragmatic hernia","volume":"3","author":"Wang","year":"2019","journal-title":"BJS Open"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1093\/ejcts\/ezx120","article-title":"The use of extracorporeal membrane oxygenation in neonates with severe congenital diaphragmatic hernia: A 26-year experience from a tertiary centre","volume":"52","author":"Vaja","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1053\/j.semperi.2017.12.005","article-title":"Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia","volume":"42","author":"Grover","year":"2018","journal-title":"Semin. Perinatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1053\/j.sempedsurg.2017.04.006","article-title":"ECMO in CDH: Is there a role?","volume":"26","author":"Kays","year":"2017","journal-title":"Semin. Pediatrics Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/j.jpedsurg.2019.01.019","article-title":"Management preferences in ECMO mode for congenital diaphragmatic hernia","volume":"54","author":"Delaplain","year":"2019","journal-title":"J. Pediatrics Surg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/1\/24\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:07:11Z","timestamp":1760159231000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/1\/24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,5]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1]]}},"alternative-id":["children8010024"],"URL":"https:\/\/doi.org\/10.3390\/children8010024","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202012.0725.v1","asserted-by":"object"}]},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,5]]}}}