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Long-Term Survival and Causes of Late Death in Children Treated With Extracorporeal Membrane Oxygenation
Viktor von Bahr1, Jan Hultman, Staffan Eksborg
11Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden. 2ECMO Center Karolinska, ECMO Department, Karolinska University Hospital, Stockholm, Sweden. 3Childhood Cancer Research Unit Q6:05, Department of Women's and Children's Health, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden. 4Department of Anesthesiology and Intensive Care, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark. 5Department of Women's and Children's Health, Pediatric Surgery, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden.
Insights
Children surviving extracorporeal membrane oxygenation (ECMO) treatment have high long-term survival rates. Prognosis is particularly favorable for those with reversible conditions like meconium aspiration syndrome.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary support technologies
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for severe circulatory or respiratory failure.
- Limited data exists on the long-term survival of pediatric patients undergoing ECMO.
Purpose of the Study:
- To determine 10-year survival rates in children treated with ECMO.
- To identify causes of late mortality in this patient population.
Main Methods:
- Retrospective cohort study at a tertiary referral center.
- Analysis of neonatal and pediatric patients treated between 1987 and 2013.
- Kaplan-Meier survival analysis utilizing national death registry data.
Main Results:
- 76% of 400 subjects survived to discharge.
- 10-year survival rates for survivors past 90 days were 93% (neonates) and 89% (pediatrics).
- Favorable survival observed in cases of meconium aspiration syndrome, trauma, and infections.
Conclusions:
- Children who survive the initial post-ECMO period demonstrate high long-term survival.
- Prognosis is significantly better for patients with reversible underlying conditions.
Objective:
Extracorporeal membrane oxygenation has been used in patients with severe circulatory or respiratory failure since the 1970s, but the knowledge on long-term survival in this group is scarce. The aim of the present study was to investigate the 10-year survival rates and causes of late death in children treated with extracorporeal membrane oxygenation.
Design:
Single-center, retrospective cohort study.
Setting:
Tertiary referral center for extracorporeal life support.
Patients:
Neonatal and pediatric patients treated with extracorporeal membrane oxygenation from 1987 to December 2013.
Interventions:
None.
Measurements And Main Results:
Survival status was obtained from the national Causes of Death registry. Patient background data along with data on survival and causes of death were collected. Survival rates were calculated using the Kaplan-Meier method. Of 400 subjects, 76% survived to discharge. The median follow-up time in survivors was 7.2 years. There was a high mortality rate within the first months after discharge. In the group of patients who survived the first 90 days after treatment, the 10-year survival rates were 93% in neonates and 89% in pediatric patients and were particularly beneficial in patients whose indication for extracorporeal membrane oxygenation was meconium aspiration syndrome, trauma, or infectious diseases. Late deaths were seen in some diagnostic groups, but the Kaplan-Meier curves plateaued over time.
Conclusions:
Children who survive the first months after treatment with extracorporeal membrane oxygenation have a high long-term survival rate. The prognosis is especially favorable in patients with reversible conditions.
