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Improving Outcomes for Children Requiring Extracorporeal Membrane Oxygenation Therapy Following Hematopoietic Stem

Taylor L Olson1, Erika R O'Neil1, Kristen J Kurtz2

  • 1Department of Pediatrics, Baylor College of Medicine, Houston, TX.

Critical Care Medicine
|January 20, 2021
PubMed

Insights

Survival rates for pediatric hematopoietic stem cell transplantation patients requiring extracorporeal membrane oxygenation have improved, reaching 26% in the last decade. This suggests extracorporeal membrane oxygenation may be increasingly viable for these complex cases.

Area of Science:

  • Pediatric critical care medicine
  • Hematology and oncology
  • Cardiopulmonary support

Background:

  • Pediatric hematopoietic stem cell transplantation (HSCT) patients often develop critical conditions requiring advanced life support.
  • Extracorporeal membrane oxygenation (ECMO) is a vital but complex therapy for pediatric critical illness.

Purpose of the Study:

  • To review survival outcomes for pediatric HSCT patients treated with ECMO.
  • To identify demographic, clinical, and complication-related factors associated with mortality in this population.

Main Methods:

  • Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) Registry (1990-2019).
  • Inclusion of pediatric patients (28 days to 18 years) with HSCT-related diagnoses undergoing ECMO.
  • Assessment of survival to hospital discharge based on demographics, clinical variables, and ECMO complications.

Main Results:

  • Overall survival for pediatric HSCT patients on ECMO was 19% across the study period.
  • Survival significantly improved in the last decade (2010-2019) to 26% (p=0.01).
  • Factors associated with decreased survival included comorbid malignancy, high peak inspiratory pressure, and pulmonary/metabolic complications.

Conclusions:

  • Pediatric HSCT patients supported with ECMO demonstrate improving survival trends.
  • The improved survival suggests HSCT may not be an absolute contraindication for ECMO.
  • Advancements in HSCT and ECMO management may broaden ECMO indications for post-HSCT patients.
Abstract

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