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Extracorporeal life support for severe respiratory failure in children with immune compromised conditions
Monika Gupta1, Thomas P Shanley, Frank W Moler
1University of Louisville, Kosair Children's Hospital, Louisville, KY, USA.
Insights
Children with immune compromise conditions (ICCs) treated with extracorporeal life support (ECLS) for respiratory failure had significantly lower survival rates. Survival was reduced across all ICC subgroups, highlighting the need for further research into these vulnerable pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Immunology
- Respiratory failure management
Background:
- Extracorporeal life support (ECLS) is a vital treatment for severe pediatric respiratory failure.
- Immune compromise conditions (ICCs) may impact outcomes in critically ill children.
- Limited data exists on survival rates for pediatric ECLS patients with ICCs.
Purpose of the Study:
- To investigate the hypothesis that pediatric patients with ICCs treated with ECLS have reduced survival to hospital discharge.
- To compare survival rates between pediatric ECLS patients with and without ICCs.
- To examine survival across different ICC subgroups.
Main Methods:
- Retrospective cohort study utilizing the Extracorporeal Life Support Organization (ELSO) registry.
- Inclusion of non-neonatal pediatric patients (1 month to 19 years) receiving ECLS for respiratory failure.
- Analysis of International Classification of Diseases (Ninth Revision) and Current Procedural Terminology codes to identify ICC status.
Main Results:
- Overall, 2,879 pediatric patients were analyzed; 183 had an ICC.
- Patients with ICCs had significantly lower hospital survival (31% vs. 57%; p < .001).
- All six examined ICC subgroups (immune deficiency, leukemia-lymphoma, cancer, opportunistic infection, solid organ transplant, bone marrow transplant) showed reduced survival, ranging from 0% to 34.6%.
Conclusions:
- Pediatric patients with ICCs receiving ECLS for respiratory failure experience substantially reduced survival to hospital discharge.
- Survival rates were diminished across all ICC subgroups, with approximately one in three overall surviving.
- Further investigation is warranted regarding the association between inhaled nitric oxide therapy and lower ECLS survival.
Objectives:
To examine a large cohort of children treated with extracorporeal life support (ECLS) for severe respiratory failure to investigate the hypothesis that patients with an immune compromise condition (ICC) would have reduced survival to hospital discharge compared with patients without this classification.
Design:
Retrospective cohort study.
Setting:
Extracorporeal Life Support Organization (ELSO) data registry.
Patients:
All nonneonatal pediatric patients receiving ECLS for respiratory failure.
Interventions:
None.
Measurements And Main Results:
As of February 4, 2004, the ELSO registry contained 2,879 pediatric patients between 1 month and 19 yrs of age who were treated with ECLS for respiratory failure. Overall, 183 patients had at least one International Classification of Diseases (Ninth Revision) or Current Procedural Terminology code associated with an ICC; ICC status was associated with lower hospital survival (31 vs. 57 %; p < .001). Six ICC subgroups were also examined: immune deficiency, leukemia-lymphoma, cancer, opportunistic infection, solid organ transplant, and bone marrow transplant. Each ICC subgroup was also associated with reduced hospital survival, varying from a high of 34.6% (solid organ transplants) to a low of 0% (bone marrow transplant). In a multivariate logistic regression model that controlled for factors reported to be associated with survival and other respiratory interventions (high-frequency ventilation, inhaled nitric oxide, and surfactant), the presence of an ICC remained associated with reduced hospital survival (odds ratio 0.20-0.45; p < .001). In this multivariate model, an unexpected strong association between inhaled nitric oxide therapy and lower ECLS survival was observed (odds ratio 0.49-0.80; p < .001).
Conclusions:
In this cohort of pediatric patients receiving ECLS for respiratory failure, survival to hospital discharge was reduced for each ICC subgroup examined and was approximately one in three for the overall group. Further study of the association of lower survival rates for patients who received inhaled nitric oxide prior to ECLS is needed.
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