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Factors associated with mortality in pediatric patients requiring extracorporeal life support for severe pneumonia

Peter C Minneci1, Todd J Kilbaugh, Heather K Chandler

  • 1Department of Surgery and Research Institute, Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|December 20, 2012
PubMed

Insights

Extracorporeal life support (ELS) can save children with pneumonia, but mortality is 39%. Key risk factors for death include ELS duration over 14 days and arterial cannulation, guiding clinical decisions.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Medicine
  • Extracorporeal Membrane Oxygenation (ECMO)

Background:

  • Pneumonia is a leading cause of respiratory failure in children.
  • Extracorporeal life support (ELS) offers a life-saving option for pediatric patients with severe respiratory failure.
  • Identifying mortality predictors in this population is crucial for optimizing care.

Purpose of the Study:

  • To identify variables associated with mortality in children with pneumonia requiring ELS.
  • To analyze prognostic factors influencing outcomes in pediatric patients on ELS for pneumonia.

Main Methods:

  • Retrospective analysis of data from the Extracorporeal Life Support Organization (ELSO) Registry.
  • Inclusion of patients ≤ 18 years old treated for pneumonia-related respiratory failure between 1985 and 2010.
  • Statistical analysis using predictive margins to estimate standardized mortality rates and risk factor differences.

Main Results:

  • A total of 1,489 children were analyzed, with an overall mortality rate of 39%.
  • Duration of ELS showed a biphasic effect: mortality decreased until 14 days, then increased.
  • Independent predictors of mortality included pre-ELS mechanical ventilation duration, peak inspiratory pressure, arterial oxygen saturation, pH, cardiac arrest, arterial cannulation, and FIO2 decrease in the first 24 hours.

Conclusions:

  • Prolonged ELS ( > 14 days), arterial cannulation, longer mechanical ventilation, and difficulty weaning FIO2 are associated with increased mortality.
  • ELSO registry analysis can identify prognostic variables to inform medical decision-making, resource allocation, and family counseling.
  • These findings aid in managing pediatric patients with severe pneumonia requiring ELS.
Abstract

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