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Adverse Outcomes in Neonates and Children with Pulmonary Artery Hypertension Supported with ECMO

Viviane G Nasr1, David Faraoni, James A DiNardo

  • 1From the *Department of Anesthesiology, Peri-operative and Pain Medicine, and †Department of Cardiology, Cardiac Intensive Care Unit, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|July 29, 2016
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) use in pediatric pulmonary artery hypertension (PAH) is linked to increased mortality and complications. This study found higher rates of death, kidney injury, and sepsis in children with PAH on ECMO compared to controls.

Area of Science:

  • Pediatric critical care medicine
  • Cardiovascular research
  • Neonatology

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a vital life support for neonates and children with severe cardiac or respiratory failure.
  • Pulmonary artery hypertension (PAH) unresponsive to conventional treatments presents a critical challenge in pediatric care.
  • Assessing ECMO outcomes in pediatric PAH is crucial for guiding clinical decision-making.

Purpose of the Study:

  • To evaluate the mortality and complication rates in neonates and children with pulmonary artery hypertension (PAH) who received ECMO support.
  • To compare outcomes between pediatric PAH patients supported with ECMO and a matched control group.

Main Methods:

  • Utilized the 2012 Health Care Cost and Use Project Kids' Database, identifying patients with PAH using ICD-9 codes.
  • Excluded children with congenital heart disease.
  • Employed propensity-matched analysis comparing ECMO patients with a control group on age, elective admission, and Elixhauser comorbidity score.

Main Results:

  • Identified 9,355 pediatric PAH cases, with 1.4% receiving ECMO.
  • Mortality was significantly higher in the ECMO group (39%) compared to the control group (8%) (OR: 6.98, p < 0.001).
  • ECMO-associated complications included acute kidney injury (OR: 2.41), neurologic issues (OR: 7.11), sepsis (OR: 2.69), and thrombotic events (OR: 2.90).

Conclusions:

  • ECMO support in neonates and children with PAH is associated with a substantially increased risk of mortality.
  • Pediatric patients with PAH on ECMO experience higher rates of severe complications, including organ dysfunction and infections.
  • These findings highlight the critical risks and suggest a need for careful consideration of ECMO in pediatric PAH management.

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