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Expanded application of extracorporeal membrane oxygenation in a pediatric surgery practice
Max Raymond Langham1, David William Kays, Elizabeth Ann Beierle
1Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, J-100286, Gainesville, FL 32610-0286, USA. langham@surgery.ulf.edu
Insights
Extracorporeal membrane oxygenation (ECMO) offers high survival rates for neonates with meconium aspiration syndrome and improves outcomes for older children and transplant recipients. This pediatric ECMO program demonstrates broad applicability and successful results across diverse conditions.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Cardiopulmonary Support
Background:
- Extracorporeal membrane oxygenation (ECMO) is established for neonatal respiratory failure.
- Limited data exist for ECMO use in older children and young adults with various conditions.
- Indications for ECMO in non-neonatal populations remain debated.
Purpose of the Study:
- To evaluate the application scope of ECMO in a university-based program.
- To assess the outcomes of ECMO therapy in pediatric patients.
- To analyze ECMO efficacy across different patient demographics and conditions.
Main Methods:
- Prospective data collection and reporting to the Extracorporeal Life Support Organization.
- Analysis of patient data based on ECMO indications and treatment outcomes.
- Review of all patients treated since the program's inception.
Main Results:
- 216 patients received 225 ECMO courses, with 188 neonates and 28 older patients.
- Overall survival rate was 81% (174 patients).
- High survival (98.5%) for meconium aspiration syndrome; 57% survival post-transplant; survival in rare conditions like severe asthma and meningitis.
Conclusions:
- ECMO can virtually eliminate mortality for meconium aspiration syndrome.
- ECMO survival rates exceed conventional therapy for neonatal and pediatric respiratory failure.
- Successful ECMO outcomes in transplant patients are comparable to other pediatric cases.
Objective:
To examine the breadth of application and resulting outcomes in a university-based extracorporeal membrane oxygenation (ECMO) program directed by pediatric surgeons.
Summary Background Data:
Several randomized control trials have supported the use of ECMO in neonates with respiratory failure. No comparable data exist for older children and young adults who may be afflicted with a variety of uncommon conditions. The indications for ECMO in these patients remain controversial.
Methods:
Patient data were recorded prospectively and reported to the Extracorporeal Life Support Organization. These data were analyzed by indications and outcomes on all patients treated since the inception of the program.
Results:
Two hundred sixteen patients were treated with 225 courses of ECMO. Neonates (188 [87%]) outnumbered 28 older patients (aged 6 weeks to 22 years). Overall, 174 patients survived (81%). Sixty-four of 65 (98.5%) neonates with meconium aspiration syndrome survived. ECMO support after heart (3), lung (2), heart-lung (1), and liver (1) transplant yielded a 57% survival to discharge. ECMO also resulted in survival of patients with uncommon conditions, including severe asthma (1), hydrocarbon aspiration (1/2), congestive heart failure due to a cerebral arteriovenous malformation (1), tracheal occlusion incurred during endoscopic stent manipulation (2), meningitis (1), and viral pneumonia (3/5).
Conclusions:
ECMO can potentially eliminate mortality for meconium aspiration syndrome. Survival for other causes of respiratory failure in neonates and older children, while not as dramatic, still surpasses that anticipated with conventional therapy. Moreover, survival of transplant patients has been comparable to that achieved in other children.
