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Pressure ulcers in paediatric patients on extracorporeal membrane oxygenation
Sophia F Tam1, Anahita Mobargha2, Joseph Tobias3
1New York Presbyterian, Columbia University Medical Center, New York, New York.
Insights
Pressure ulcers are a risk for critically ill children on extracorporeal membrane oxygenation (ECMO). Older age, higher weight, longer ECMO duration, and femoral cannulation were associated with pressure ulcer development.
Area of Science:
- Pediatric Critical Care Medicine
- Medical Device Technology
- Patient Safety
Background:
- Pressure ulcers significantly increase morbidity and mortality in critically ill pediatric patients.
- Extracorporeal membrane oxygenation (ECMO) is a vital life support therapy for critically ill children.
- Identifying risk factors for pressure ulcers in pediatric ECMO patients is crucial for improving outcomes.
Purpose of the Study:
- To identify factors associated with pressure ulcer formation in pediatric patients undergoing ECMO.
- To compare characteristics between pediatric ECMO patients who developed pressure ulcers and those who did not.
Main Methods:
- Retrospective cohort study of pediatric patients on ECMO from December 2014 to 2015.
- Comparison of patient demographics, ECMO parameters, and clinical variables between ulcer and no-ulcer groups.
- Analysis included age, weight, ECMO type and duration, cannula site, fluid and blood product volumes, laboratory values, and medication use.
Main Results:
- 11 out of 43 (25.5%) pediatric ECMO patients developed pressure ulcers.
- Patients with pressure ulcers were older (P=0.001) and had higher weight (P=0.006).
- Femoral cannulation (36.4% vs 6.3%, P=0.029) and longer ECMO duration (P=0.007) were significantly associated with pressure ulcer development.
Conclusions:
- Age, weight, duration of ECMO, and femoral cannulation are potential contributing factors to pressure ulcer development in pediatric ECMO patients.
- Further research is needed to develop specific prevention strategies and protocols.
- Implementing targeted interventions may reduce the incidence of pressure ulcers in this vulnerable population.
Abstract:
It has been shown that pressure ulcer formation in critically ill paediatric patients increases morbidity and mortality. We sought to identify factors associated with pressure ulcer formation in paediatric patients on extracorporeal membrane oxygenation (ECMO). From December 2014 to 2015, we identified patients at our institution who developed a pressure ulcer to create two cohorts: ulcer and no ulcer. Variables of interest included: type of ECMO, ECMO indication, hours on ECMO, location of cannulas, volume of crystalloid and blood products received during the first 7 days or during the length of the ECMO run, albumin and lactate levels on the day of cannulation, and presence of vasopressor support or steroid therapy. Of 43 patients studied, 11 (25.5%) developed a pressure ulcer. Patients that developed ulcers were older (P = 0.001) and weighed more (P = 0.006). Femoral cannulation was more frequent in the ulcer group (36.4% vs 6.3%, P = 0.029), and duration of ECMO was longer (P = 0.007). Age, weight, duration of ECMO, and femoral cannulation may contribute to the development of pressure ulcers in children who require ECMO support. Further analysis is imperative to identify specific techniques and protocols that will prevent pressure ulcers in this critically ill population.
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