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Clinical Characteristics and Outcomes of Children With Extracorporeal Membrane Oxygenation in a Developing Country:
Wirapatra Iamwat1, Piya Samankatiwat2, Rojjanee Lertbunrian1
1Division of Pediatric Critical Care, Department of Pediatric, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Extracorporeal Membrane Oxygenation (ECMO) can save critically ill children, but pre-existing acute kidney injury, delayed enteral feeding, and coagulopathy increase mortality risk. Successful ECMO implementation is feasible even in developing countries.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Support
- Extracorporeal Life Support
Background:
- Extracorporeal Membrane Oxygenation (ECMO) is a vital intervention for pediatric patients with severe cardiac or respiratory failure.
- The application of ECMO is expanding, necessitating a thorough understanding of its associated risks and benefits in pediatric populations.
- Identifying factors influencing outcomes is crucial for optimizing ECMO therapy in children.
Purpose of the Study:
- To identify mortality risk factors in pediatric patients undergoing ECMO.
- To evaluate the outcomes of ECMO in a pediatric cohort.
- To assess the feasibility of ECMO in a developing country context.
Main Methods:
- Retrospective chart review of pediatric patients (1 day-20 years) who received ECMO from January 2010 to December 2020.
- Analysis of patient demographics, indications for ECMO, and clinical outcomes.
- Statistical analysis to determine factors associated with mortality.
Main Results:
- Seventy pediatric patients received ECMO, with a median age of 31.3 months. The most common indication was failure to wean from cardiopulmonary bypass post-cardiac surgery.
- Pre-existing acute kidney injury (OR 4.23), delayed enteral feeding (OR 3.85), and coagulopathy (OR 12.64) were significantly associated with increased mortality.
- Overall ECMO survival was 70%, with a survival to discharge rate of 50%.
Conclusions:
- ECMO is a life-saving therapy for critically ill children with cardiopulmonary failure.
- Pre-existing acute kidney injury, delayed enteral feeding, and coagulopathy are key risk factors for poor outcomes in pediatric ECMO patients.
- Successful ECMO implementation is achievable in developing countries, offering hope for wider access to this critical treatment.
Abstract:
Introduction: Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving procedure for patients with refractory cardiac or respiratory failure. The indications for ECMO are growing, and it is increasingly being used to support cardiopulmonary failure in children. However, the risks and benefits of ECMO should be weighed before deploying it on the patients. The objectives of this study were to identify the mortality risk factors and to determine the ECMO outcomes. Methods: The retrospective chart reviews were done for all patients aged 1 day-20 years old receiving ECMO between January 2010 and December 2020. Results: Seventy patients were enrolled in the study. The median age was 31.3 months. The incidence of VA and VV ECMO was 85.7 and 14.3%, respectively. The most common indication for ECMO was the failure to wean off cardiopulmonary bypass after cardiac surgery. Pre-existing acute kidney injury (OR 4.23; 95% CI 1.34-13.32, p = 0.014) and delayed enteral feeding (OR 3.85, 95% CI 1.23-12.02, p = 0.020), and coagulopathy (OD 12.64; 95% CI 1.13-141.13, p = 0.039) were associated with the higher rate of mortality. The rates of ECMO survival and survival to discharge were 70 and 50%, respectively. Conclusion: ECMO is the lifesaving tool for critically ill pediatric patients. Pre-existing acute kidney injury, delayed enteral feeding, and coagulopathy were the potential risk factors associated with poor outcomes in children receiving ECMO. However, ECMO setup can be done successfully in a developing country.
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