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Pediatric Extracorporeal Life Support Organization Registry International Report 2016
Ryan P Barbaro1, Matthew L Paden, Yigit S Guner
1From the *Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, Michigan; †Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia; ‡Department of Surgery, University of California Irvine Medical Center, Irvine, California; §Department of Pediatrics, University of Texas Southwestern, Dallas, Texas; ¶Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada; ‖Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; #Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; **Department of Anesthesiology and Critical Care Medicine, John Hopkins University, Baltimore, Maryland; and ††Extracorporeal Life Support Organization, Ann Arbor, Michigan.
Insights
Pediatric extracorporeal life support (ECLS) use increased significantly from 2009-2015. While survival rates reached 61%, adverse events highlight the need for quality improvement in pediatric ECLS.
Area of Science:
- Pediatric critical care medicine
- Extracorporeal membrane oxygenation (ECMO) and life support technologies
Background:
- Extracorporeal life support (ECLS) is a vital intervention for critically ill children.
- The Extracorporeal Life Support Organization (ELSO) Registry provides a global dataset for ECLS research.
Purpose of the Study:
- To analyze the international trends in pediatric ECLS from 2009 to 2015.
- To report on outcomes, complications, and technology utilized in pediatric ECLS.
- To identify areas for quality improvement in pediatric ECLS.
Main Methods:
- Retrospective analysis of data from the ELSO Registry (2009-2015).
- Inclusion of all pediatric patients (<18 years) receiving ECLS.
- Categorization of ECLS use by indication (respiratory, cardiac, ECPR) and patient demographics.
Main Results:
- A 24% increase in pediatric ECLS cases and a 55% growth in participating centers were observed between 2009 and 2015.
- Overall survival to hospital discharge was 61% for 21,907 pediatric ECLS cases since 2009.
- Respiratory support in neonates was the most common ECLS application; 48% for respiratory, 52% for cardiac support or ECPR.
- Centrifugal pumps (51%) and polymethylpentene oxygenators (52%) were the predominant technologies used.
- Adverse events, including neurologic complications, were frequently reported.
Conclusions:
- Pediatric ECLS utilization has expanded globally, with notable growth in centers and patient numbers.
- While survival rates are encouraging, the incidence of adverse events necessitates ongoing quality improvement initiatives.
- Further research into optimizing ECLS technology and protocols is crucial for improving pediatric patient outcomes.
Abstract:
The purpose of this report is to describe the international growth, outcomes, complications, and technology used in pediatric extracorporeal life support (ECLS) from 2009 to 2015 as reported by participating centers in the Extracorporeal Life Support Organization (ELSO). To date, there are 59,969 children who have received ECLS in the ELSO Registry; among those, 21,907 received ECLS since 2009 with an overall survival to hospital discharge rate of 61%. In 2009, 2,409 ECLS cases were performed at 157 centers. By 2015, that number grew to 2,992 cases in 227 centers, reflecting a 24% increase in patients and 55% growth in centers. ECLS delivered to neonates (0-28 days) for respiratory support was the largest subcategory of ECLS among children <18-years old. Overall, 48% of ECLS was delivered for respiratory support and 52% was for cardiac support or extracorporeal life support to support cardiopulmonary resuscitation (ECPR). During the study period, over half of children were supported on ECLS with centrifugal pumps (51%) and polymethylpentene oxygenators (52%). Adverse events including neurologic events were common during ECLS, a fact that underscores the opportunity and need to promote quality improvement work.
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