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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
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Extracorporeal Membrane Oxygenation Mortality in High-Risk Populations: An Analysis of the Pediatric Health

Ryan D Coleman1, Jordana Goldman1, Brady Moffett2

  • 1From the Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|May 3, 2019
PubMed

Insights

Extracorporporeal membrane oxygenation (ECMO) use in children has risen, but outcomes vary by condition. Bone marrow transplant, leukemia, and neutropenia significantly increase mortality risk in pediatric ECMO patients.

Area of Science:

  • Pediatric critical care medicine
  • Cardiovascular research
  • Hematology/Oncology

Background:

  • Extracorporporeal membrane oxygenation (ECMO) use in children is increasing.
  • A growing number of pediatric patients with complex conditions are now ECMO candidates.
  • The impact of specific underlying diseases on ECMO outcomes remains unclear.

Purpose of the Study:

  • To evaluate the association between specific high-risk diagnoses and mortality in pediatric ECMO patients.
  • To compare outcomes for children with complex congenital heart disease (CHD), malignancy, bone marrow transplant, or genetic abnormalities on ECMO.

Main Methods:

  • Retrospective study using the Pediatric Health Information System database (2004-2013).
  • Identified 9,194 pediatric ECMO cases.
  • Compared outcomes of 2,200 "high-risk" patients (e.g., bone marrow transplant, leukemia, complex CHD) against overall ECMO population.

Main Results:

  • Bone marrow transplant (81% mortality), leukemia (66% mortality), and neutropenia (58% mortality) were linked to significantly higher ECMO mortality.
  • Complex CHD (52% mortality) and genetic syndromes (48% mortality) did not show increased mortality risk compared to the overall cohort.
  • Odds ratios indicated increased mortality for bone marrow transplant (3.49), leukemia (1.88), and neutropenia (1.62).

Conclusions:

  • Specific hematologic and oncologic conditions, such as bone marrow transplant and leukemia, are associated with substantially higher mortality in pediatric ECMO patients.
  • Complex CHD and genetic syndromes, while serious, did not independently increase mortality risk in this pediatric ECMO cohort.
  • Findings aid clinicians and families in risk-benefit assessments for ECMO candidacy in critically ill children with complex underlying conditions.

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