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Early Fluid Accumulation and Intensive Care Unit Mortality in Children Receiving Extracorporeal Membrane Oxygenation

Pilar Anton-Martin1, Raymond Quigley2, Archana Dhar3

  • 1From the Department of Pediatrics, Division of Cardiology - Cardiac Critical Care, University of Tennessee Medical Science Center / Le Bonheur Children's Hospital, Memphis, Tennessee.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|May 21, 2020
PubMed

Insights

Early fluid accumulation in children undergoing extracorporeal membrane oxygenation (ECMO) significantly increases intensive care unit (ICU) mortality. This finding highlights the importance of monitoring fluid balance in pediatric ECMO patients.

Area of Science:

  • Pediatric Critical Care Medicine
  • Extracorporeal Membrane Oxygenation (ECMO)
  • Nephrology

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill neonates and children.
  • Fluid accumulation and acute kidney injury (AKI) are common complications during ECMO.
  • The impact of early fluid overload on mortality in pediatric ECMO patients requires further elucidation.

Purpose of the Study:

  • To evaluate the association between early fluid accumulation and renal dysfunction with mortality in pediatric patients receiving ECMO.
  • To identify risk factors for mortality in neonatal and pediatric ECMO patients.

Main Methods:

  • Retrospective cohort study of 96 neonatal and pediatric patients who received ECMO.
  • Data collected on fluid balance, acute kidney injury (AKI), continuous renal replacement therapy (CRRT), and mortality.
  • Multivariable logistic regression analysis adjusted for a propensity score.

Main Results:

  • Overall mortality was 38.5%.
  • Nonsurvivors had a higher proportion of AKI at ICU admission and greater fluid accumulation on ECMO day 1.
  • Fluid accumulation within 24 hours of ECMO initiation was significantly associated with increased ICU mortality (OR: 1.07, p = 0.04).

Conclusions:

  • Early fluid accumulation in the first 24 hours after ECMO cannulation is a significant predictor of increased ICU mortality in pediatric patients.
  • Conservative fluid management strategies and the role of CRRT during early ECMO warrant further investigation in prospective studies.

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