[Investigation on extracorporeal membrane oxygenation application in pediatric intensive care unit in China]

To review the use of non-open chest extracorporeal membrane oxygenation (ECMO) in pediatric intensive care unit (PICU) in China.

The survey was conducted in 28 tertiary hospitals in China mainland from March to October 2015. All children <18 years of age have been supported with non-open chest ECMO in PICU were reviewed.Patient demographics, diagnosis, indication for ECMO, details of ECMO support, complications, and patient survival were analyzed. All the patients were divided according to age into pediatric patients (age>28 d) and neonatal patients (age 0-28 d). For non-normally distributed measurement data, two groups were compared using independent samples of the Mann Whitney U test and for categorical data constitute ratio were compared by χ(2) test or Fisher's exact test.

A total of 63 patients received non-open chest ECMO support during this study, including 51 pediatric patients and 12 neonates. For 51 pediatric patients, their mean age was 55.5 (15.0-117.0) months, and mean weight was 17.5 (10.0-32.9) kg. Cardiac failure was the primary indication in 28 patients, respiratory failure in 21 patients, and both cardiac and respiratory in 2 patients. Patients with cardiac disease had a lower mortality rate compared with cases with respiratory disease (21%(6/28) vs. 67% (14/21), χ(2)=9.145, P=0.002). The average length of ECMO run was 112.0 (74.5-175.2) h, and 96.7(76.2-139.5)h for cardiac patients, 149.0(78.9-241.0)h for patients with respiratory disease. There were no significant difference between patients with cardiac disease and patients with respiratory disease in ECMO support time (Z=1.476, P=0.140). Forty-two patients (82%) were decanulated from ECMO successfully, and thirty-one (61%) patients survived to hospital discharge. The most common complications during ECMO run were bleeding, hemolysis and disfunction of oxygenation. Of the 25 (49%) survivors whom we followed up, 8 (17%) experienced obvious sequelae, and 5 (10%) had neurologic problems. Of twelve neonates, their mean weight was(3.2±0.5)kg. The primary cause of ECMO was neonatal respiratory distress syndrome(7 cases). All of the neonatal patients were treated with veno-arterial (VA)-ECMO. The mean duration of ECMO support was 88.4 (45.50-110.25) h. Seven patients were decanulated from ECMO successfully, five survived to hospital discharge.

ECMO support can significantly improve the prognosis of pediatric and neonatal patients with refractory respiratory and cardiac failure. More efforts are needed on patient selection, experienced team establishment and ECMO therapy technology improvement need further improvement in China in the future.