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Role of extracorporeal membrane oxygenation in selected pediatric respiratory problems
C W Lillehei1, P P O'Rourke, J P Vacanti
1Department of Surgery, Children's Hospital, Boston, MA 02115.
Insights
Extracorporeal membrane oxygenation (ECMO) effectively supported 89 children with severe respiratory failure, achieving a 71% survival rate. This vital treatment offers a crucial window for medical or surgical intervention in pediatric respiratory emergencies.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Support
- Neonatal Respiratory Distress
Background:
- Severe respiratory failure in infants and children presents significant mortality risks.
- Established treatment options for severe pediatric respiratory failure are limited.
- Extracorporeal membrane oxygenation (ECMO) offers advanced cardiopulmonary support.
Purpose of the Study:
- To evaluate the efficacy and outcomes of extracorporeal membrane oxygenation (ECMO) in pediatric patients with severe respiratory failure.
- To analyze survival rates and complications associated with ECMO in this population.
- To determine the impact of diagnosis and time on ECMO outcomes.
Main Methods:
- Retrospective analysis of 89 pediatric patients treated with ECMO between 1984 and 1988.
- Inclusion criteria: predicted mortality rate ≥80% (oxygenation index >0.4).
- Venoarterial bypass via right cervical cannulation (common carotid artery and internal jugular vein).
Main Results:
- Overall survival rate was 71%, with significant variation by diagnosis.
- Congenital diaphragmatic hernias, meconium aspiration syndrome, and sepsis were major indications.
- Average ECMO duration was 5.7 days; intracranial hemorrhage occurred in 16% of patients.
Conclusions:
- ECMO provides effective cardiopulmonary support for selected pediatric respiratory conditions.
- The therapy offers a critical time window for reversible pediatric respiratory pathologies.
- Survival rates improved over time, suggesting evolving clinical management and patient selection.
Abstract:
Between 1984 and 1988, 89 infants and children with severe respiratory failure were supported by extracorporeal membrane oxygenation. Major clinical diagnoses included congenital diaphragmatic hernias (34), meconium aspiration syndrome (26), and sepsis (8). Extracorporeal membrane oxygenation was used for patients with a predicted mortality rate of at least 80% based on an oxygenation index greater than 0.4. Venoarterial bypass was accomplished by way of right cervical cannulation of the common carotid artery and internal jugular vein. Overall survival was 71% but varied widely by diagnosis and progressively improved over time. The average extracorporeal membrane oxygenation run was 5.7 days. Intracranial hemorrhage was the most serious complication occurring in 16% of patients. Mechanical circuit complications were seen in 22% but rarely related to significant morbidity. Extracorporeal membrane oxygenation appears to provide effective cardiopulmonary support for selected pediatric respiratory problems. It affords those with potentially reversible pathophysiology the temporal opportunity for successful medical or surgical therapies.