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[The application of extracorporeal membrane oxygenation in children in China]
1Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai 200127, China.
Insights
Extracorporeal membrane oxygenation (ECMO) use in Chinese children has grown since 2004, with pediatric patients showing better outcomes than neonates. While teams are forming, outcomes still lag behind international standards.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary support technologies
- Neonatal intensive care
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital life support technology for critically ill patients.
- Its application in pediatric and neonatal populations presents unique challenges and requires specialized expertise.
- Understanding the current landscape of ECMO use in China is crucial for improving patient care.
Purpose of the Study:
- To assess the current application and outcomes of ECMO in pediatric and neonatal patients in China.
- To identify trends in ECMO utilization based on age and indication.
- To evaluate the survival rates and identify areas for improvement in pediatric ECMO programs.
Main Methods:
- A nationwide questionnaire survey was conducted among tertiary hospitals in China.
- Data collected included the number of ECMO cases, patient demographics (pediatric vs. neonatal), indications (cardiac, respiratory, ECPR), and survival outcomes (weaned, discharged).
- Information on the departments involved in ECMO management was also acquired.
Main Results:
- 30 out of 43 surveyed tertiary hospitals utilize ECMO in children, with 800 patients supported since 2004.
- Pediatric patients (658) had higher survival rates compared to neonates (142), particularly for cardiac and respiratory indications.
- Overall discharge rates varied by indication and age group, with pediatric cardiac ECMO showing 47.5% survival and neonatal respiratory ECMO showing 52.5% survival.
Conclusions:
- ECMO application in Chinese pediatrics, though initiated relatively recently, has accumulated a significant number of cases.
- There is a notable disparity in outcomes between pediatric and neonatal populations, and a gap exists when compared to international benchmarks.
- Preliminary ECMO teams have been established in Chinese hospitals, indicating a foundational step towards developing robust programs.
Abstract:
Objective: To investigate the application of extracorporeal membrane oxygenation (ECMO) in pediatrics in China as well as the outcomes. Methods: Data was conducted by questionnaire to investigate the use of ECMO in children under the age of 18 in China by June 30, 2017. All patients were divided into two age groups: pediatric patients (29 d-18 y) and neonates (1-28 d); Also by the causes of ECMO treating including cardiac, respiratory and extracorporeal cardiopulmonary resuscitation (ECPR). The form included the numbers of ECMO cases, weaned and discharged cases, according to the different ages and causes. In addition, the departments that routinely participate in ECMO management were acquired. Results: Totally 43 tertiary hospitals were enrolled, of which 30 have implemented ECMO for the children patients (comprising pediatrics and neonates), including 14 general hospitals, 5 cardiothoracic specialty hospitals and 11 children's or women and children's hospitals. ECMO for pediatrics and neonates was firstly carried out at mainland China in 2004. To the deadline of investigation, 800 patients were supported with ECMO, among which 658 were pediatrics, much more than 142 of neonates. As to pediatrics, 453 were supported with ECMO for cardiac indications with 287 (63.4%) weaned off and 215 (47.5%) survived to discharge; for respiratory causes, 79 cases were registered with 47 (59.5%) weaned off and 36 (45.6%) discharged; for ECPR, 126 were enrolled with 62 (49.2%) successfully weaned off and 48 (38.1%) discharged. In contrast, neonatal patients undergoing cardiac ECMO contained 79 cases, with 39 (49.4%) weaned off and 26 (32.9%) discharged; due to respiratory causes, 40 neonates were included, with 26 (65.0%) weaned off and 21 (52.5%) discharged; 23 neonatal patients consisted of ECPR cause and 10 (43.5%) of them successfully weaned off, but only 6 (26.1%) finally survived. Among the 30 hospitals conducted ECMO for pediatrics and neonates, the average number of departments for ECMO management is 4.03±1.87. Conclusions: Although ECMO used for children in mainland China is relatively late, a certain number of cases have been accumulated, and there is still a gap compared with the international standard. Meanwhile, each hospital has preliminarily built up its own ECMO team.
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