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Published on: November 17, 2013
Glycemic control in pediatric patients on extracorporeal membrane oxygenation
Kathryn L Wierer1, Rachel A Pagryzinski, Qun Xiang
1Department of Pharmacy, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
Insights
Glycemic control did not impact survival rates for pediatric patients on extracorporeal membrane oxygenation (ECMO) therapy. However, controlled glucose levels were associated with longer ECMO duration in this patient group.
Area of Science:
- Pediatric critical care medicine
- Metabolic disorders
- Cardiopulmonary support
Background:
- Extracorporporeal membrane oxygenation (ECMO) is a life-support measure for critically ill pediatric patients with cardiorespiratory failure.
- Glycemic control is a critical factor in managing critically ill patients, but its impact on ECMO outcomes is not fully understood.
Purpose of the Study:
- To investigate the association between glycemic control and outcomes in pediatric patients undergoing ECMO therapy.
- To identify if maintaining specific serum glucose ranges influences mortality and duration of ECMO support.
Main Methods:
- A retrospective chart review of 82 pediatric patients requiring ECMO between 2008 and 2010.
- Analysis of all serum glucose concentrations during ECMO, alongside other potential mortality-influencing factors.
- Primary outcome: mortality; Secondary outcomes: ECMO duration, time to death or discharge.
Main Results:
- Overall survival rate for ECMO was 64.6% (53 out of 82 patients).
- Glycemic control (serum glucose 60-250 mg/dL >95% of the time) showed no statistically significant effect on ECMO survival or hospital mortality.
- Patients with controlled glucose levels experienced a significantly longer duration on ECMO (average 31.5% increase, p=0.048).
Conclusions:
- Glycemic control, within the defined range, did not significantly impact mortality for pediatric ECMO patients.
- Further research into specific glucose control protocols may be warranted to explore potential effects on morbidity and mortality.
Abstract:
OBJECTIVES To determine whether glycemic control has an effect on outcomes for pediatric patients on extracorporeal membrane oxygenation (ECMO) therapy, while controlling for multiple factors. METHODS A single-center retrospective chart review was performed on 82 patients who required ECMO from January 1, 2008, to December 31, 2010. All glucose concentrations collected while patients were on ECMO were analyzed; multiple other factors that may have affected mortality were also recorded. Primary outcome was mortality, and secondary outcomes were length of time on ECMO and length of time until death or discharge from the hospital. RESULTS Of 82 patients, 53 patients survived ECMO (64.6%). Glucose control had no effect on survival of patients on ECMO (p=0.56), even when controlling for multiple factors (p=0.48). Similarly, statistical evaluation showed no differences for hospital mortality in relationship to controlled serum glucose (p=0.50). Patients with controlled glucose spent an average of 31.5% more time on ECMO than non-controlled patients (p=0.048). CONCLUSIONS In this study, glycemic control, defined as serum glucose concentration between 60 mg/dL and 250 mg/dL for >95% of the time on ECMO, had no statistically significant effect on mortality for patients on ECMO. Future studies could focus on tighter glucose control or specific dextrose/glucose protocols to evaluate whether improved glucose control would have an effect on morbidity and mortality.
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