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Mechanical component failures in 28,171 neonatal and pediatric extracorporeal membrane oxygenation courses from 1987
Geoffrey M Fleming1, James G Gurney, Janet E Donohue
1Monroe Carell Jr Children's Hospital, Vanderbilt University, Nashville, TN, USA. geoffrey.fleming@vanderbilt.edu
Objective:
To provide a descriptive summary of mechanical component failure associated with extracorporeal membrane oxygenation (ECMO), and to examine patient and ECMO variables that may be associated with mechanical component failure and guide further study. We hypothesized that duration of ECMO, era of ECMO, indication for ECMO, age of patient, and center ECMO volume would be associated with mechanical component failure.
Design:
Retrospective cohort study.
Patients And Methods:
Extracorporeal Life Support Organization registry was queried for all neonatal and pediatric ECMO courses recorded. Each ECMO course was treated as an independent event, and was included if duration was > or =25 hrs with occurrence between 1987 and 2007. Courses with a duration >458 hrs or with an indication for ECMO during cardiopulmonary resuscitation were excluded from analysis. Mechanical component failure data were extracted from the Extracorporeal Life Support Organization registry for the oxygenator, raceway, other tubing, pigtail connectors, heat exchanger, and air in the circuit.
Results:
A total of 28,171 independent ECMO courses were included for analysis, of which 14.9% were associated with a mechanical component failure. Duration of ECMO, age group of patient, era of ECMO, and indication for ECMO were all associated with mechanical component failure. From our predictive model, we observed a continuous nonlinear relation suggesting increasing probability of mechanical component failure with increasing duration of ECMO support.
Conclusions:
Mechanical component failure over the course of this study was infrequent during neonatal and pediatric ECMO, and declined across eras as experience with the therapy grew. Increasing duration of ECMO was associated with an increasing probability of mechanical component failure. Indication for ECMO and patient age were also statistically associated with mechanical component failure probability, but ECMO center volume was not.
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