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Pediatric extracorporeal membrane oxygenation in posttraumatic respiratory failure
R B Steiner1, V R Adolph, J F Heaton
1Department of Pediatrics, Ochsner Clinic, New Orleans, LA.
Insights
Extracorporeal membrane oxygenation (ECMO) can aid pediatric trauma patients with respiratory failure. Survival rates varied by cause, with blunt trauma showing better outcomes than near-drowning incidents.
Area of Science:
- Pediatric Critical Care Medicine
- Trauma Surgery
- Cardiopulmonary Support
Background:
- Trauma is the leading cause of death in US children.
- Pediatric respiratory failure presents unique challenges in treatment and outcomes.
- Extracorporeal membrane oxygenation (ECMO) is a vital support system for severe respiratory failure.
Observation:
- A retrospective review analyzed 14 pediatric patients (blunt trauma and near-drowning) requiring ECMO for respiratory failure.
- Patients received standard venoarterial ECMO with common carotid artery and internal jugular vein access.
- Survivors in the blunt trauma group had higher pre-ECMO PO2 levels compared to non-survivors.
Findings:
- Survival rates were 4/6 for blunt trauma and 3/8 for near-drowning.
- Higher pre-ECMO PO2 was associated with survival.
- Multisystem organ failure and sepsis were common causes of death in non-survivors.
Implications:
- ECMO may be a viable option for pediatric traumatic respiratory failure.
- Early identification of patients likely to benefit from ECMO is crucial.
- Further research is needed to optimize ECMO protocols and improve outcomes in pediatric critical care.
Abstract:
The leading cause of death in the pediatric population in the United States is trauma. A retrospective review of patients treated with extracorporeal membrane oxygenation (ECMO) for traumatic respiratory failure was performed. Eight children were treated at the Ochsner Medical Foundation and additional data on six children were available from the National Registry. Six children developed respiratory failure as a result of blunt trauma and eight as a result of near drowning. Standard venoarterial ECMO was used with a circuit very similar to that used in neonatal ECMO. Vascular access was via the common carotid artery and the internal jugular vein. Ventilatory support was weaned to minimal settings during ECMO. Central hyperalimentation and systemic antibiotics were used in all of the cases. Four of six children survived in the blunt trauma group; three of eight children survived in the near drowning group. Although significant conclusions cannot be drawn from a small group of patients the average pre-ECMO PO2 for survivors was 87 mm Hg, whereas for nonsurvivors the average PO2 was only 46 mm Hg. Ventilatory support for both groups was not remarkably different, and the average PCO2 was lower in the nonsurvivor group. The cause of death in this group of patients is usually multisystem organ failure. In the four patients treated at Ochsner who did not survive, all had positive blood cultures and presumed systemic sepsis. ECMO has been demonstrated to be very successful in neonatal respiratory failure. Predicting mortality and morbidity in pediatric respiratory failure has been more difficult.(ABSTRACT TRUNCATED AT 250 WORDS)