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Update and outcomes in extracorporeal life support
Matthew L Paden1, Peter T Rycus2, Ravi R Thiagarajan3
1Division of Critical Care, Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA.
Seminars in Perinatology
|March 4, 2014
Summary
Extracorporeal life support (ECLS) use has shifted from neonates to pediatric and adult patients over 24 years. While neonatal ECLS declined, pediatric and adult ECLS cases significantly increased, showing evolving ECLS applications.
Area of Science:
- Critical Care Medicine
- Pediatric Cardiology
- Neonatal Intensive Care
Background:
- The Extracorporeal Life Support Organization (ELSO) Registry has amassed data on nearly 56,000 patients over 24 years.
- Neonatal respiratory extracorporeal life support (ECLS) use has decreased since its 1992 peak.
Purpose of the Study:
- To analyze trends in ECLS utilization across different patient populations (neonatal, pediatric, adult) and indications (respiratory, cardiac).
- To report survival rates associated with ECLS in various demographic groups.
Main Methods:
- Retrospective analysis of the ELSO Registry data spanning 24 years.
- Categorization of ECLS cases by age group (neonatal, pediatric, adult) and indication (respiratory, cardiac).
Main Results:
- Neonatal respiratory ECLS cases decreased from 1516 in 1992 to 750-865 (2008-2012), representing less than 50% of total cases in 2013.
- Pediatric respiratory ECLS cases grew from ~200/year (1993-2004) to 331-448/year (2008-2012) with 58% survival.
- Adult respiratory ECLS cases increased from ~100/year (1996-2007) to 480-846/year (2009-2012) with 58% survival.
- Cardiac ECLS patient survival rates are 40% (neonates), 49% (pediatrics), and 40% (adults).
Conclusions:
- ECLS utilization patterns have shifted, with a notable decline in neonatal respiratory cases and significant growth in pediatric and adult respiratory ECLS.
- Survival rates for ECLS vary by age and indication, highlighting the need for continued research and optimized treatment strategies.
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