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The Use of Extracorporeal Life Support in Children With Immune-Mediated Diseases

Jessica A Barreto1, Amit Mehta2, Ravi R Thiagarajan3

  • 1Department of Pediatrics, Division of Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|July 15, 2021
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) can support children with immune-mediated conditions, with an overall survival rate of 50%. Survival varied significantly by diagnosis, with some conditions having very low survival rates.

Area of Science:

  • Pediatric critical care medicine
  • Immunology
  • Cardiopulmonary support

Background:

  • Immune-mediated conditions can lead to severe organ dysfunction requiring advanced life support.
  • Extracorporeal membrane oxygenation (ECMO) is a vital tool for managing critically ill children.
  • Limited data exists on ECMO use and outcomes specifically for pediatric patients with immune-mediated diseases.

Purpose of the Study:

  • To describe the utilization and outcomes of ECMO in children diagnosed with immune-mediated conditions.
  • To identify factors influencing survival in this patient population.
  • To analyze survival rates based on the indication for ECMO and specific diagnoses.

Main Methods:

  • Retrospective cohort study utilizing the Extracorporeal Life Support Organization (ELSO) registry.
  • Inclusion criteria: Patients aged 1 month to 18 years with ICD-9/10 codes for immune-mediated conditions (1989-2018).
  • Analysis of ECMO support type (respiratory, cardiac, cardiopulmonary resuscitation) and associated survival rates.

Main Results:

  • 207 pediatric patients with immune-mediated conditions received ECMO; 50% survived to discharge.
  • Respiratory support was most common (63%), with 53% survival. Cardiopulmonary resuscitation had the lowest survival (34%).
  • Hemophagocytic lymphohistiocytosis/macrophage activation syndrome had 37% survival. Juvenile idiopathic arthritis and dermatomyositis showed the lowest survival rates (23% and 25%).

Conclusions:

  • ECMO can be successfully employed to support pediatric patients with immune-mediated conditions.
  • There has been an increasing trend in ECMO utilization for these patients over time.
  • Survival outcomes are highly variable and depend significantly on the underlying immune-mediated diagnosis.
Abstract

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