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Treatment of acute pulmonary failure with extracorporeal support: 100% survival in a pediatric population
Insights
Extracorporeal lung support offers a 100% survival rate for children with acute respiratory failure, enabling successful ventilator weaning. This critical intervention provides vital support for pediatric patients facing severe pulmonary conditions.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Extracorporeal Membrane Oxygenation (ECMO)
Background:
- Acute, unrelenting pulmonary failure in children necessitates advanced life support.
- Extracorporeal lung support (ELS) is a critical intervention for pediatric respiratory failure unresponsive to maximal medical management.
- Established criteria for ELS initiation were exceeded in this cohort, highlighting the severity of their conditions.
Observation:
- Five children (10 days to 6.5 years) with diffuse parenchymal lung disease and progressive hypoxemia/hypercapnia were treated with ELS.
- Conditions included viral pneumonia (RSV, herpes simplex), pulmonary hemorrhage, and ARDS secondary to toxic epidermal necrolysis and cat scratch disease.
- Venoarterial and venovenous ELS configurations were utilized, with open lung biopsies revealing moderate to severe ARDS.
Findings:
- 100% immediate survival was achieved in all five pediatric patients treated with ELS.
- Average duration of ELS was 330 hours, with successful weaning from mechanical ventilation.
- Average time to extubation was 23.2 days, demonstrating effective recovery post-support.
Implications:
- ELS is a highly effective life-saving therapy for pediatric acute respiratory failure.
- This study demonstrates the feasibility and success of ELS in a severe pediatric population.
- Further research into optimal ELS strategies for pediatric respiratory failure is warranted.
Abstract:
Since February 1990, five children, aged 10 days to 6.5 years, were treated with extracorporeal lung support at our hospital for acute, unrelenting pulmonary failure. Two had viral pneumonia: one with respiratory syncytial virus (RSV) bronchiolitis, and one with herpes simplex virus pneumonia, encephalitis, and disseminated intravascular coagulation. One presented with a febrile illness followed by a pulmonary hemorrhage. Two patients had adult respiratory distress syndrome (ARDS) complicating severe systemic illnesses, toxic epidermal necrolysis in one and cat scratch disease with encephalitis in the other. All children had diffuse parenchymal lung disease by chest x-ray. On maximum medical management all patients were developing carbon dioxide retention and progressive hypoxemia, exceeding previously established NIH study criteria for extracorporeal treatment. Three children (10 days, 2 months, 13 months) were placed on venoarterial support and two children (20 months and 6.5 years) were placed on venovenous extracorporeal support (ECCO2R). Three of the five had open lung biopsies performed, which showed findings consistent with a moderate to severe cellular phase of ARDS. No viral inclusions were found in the patient with RSV infection. One hundred percent immediate survival was achieved in this patient population. Average duration of support was 330 hours (range, 89 to 840). Following completion of extracorporeal support, all children were successfully weaned from the ventilator with an average time to extubation of 23.2 days (range, 2 to 58 days). One child died of congestive heart failure following palliative surgery for a complex noncyanotic congenital cardiac lesion 35 days after successfully weaning from extracorporeal support for an acute febrile illness and pulmonary hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)