Complication accrual impacts pediatric extracorporeal life support mortality

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Lauren E Adams1, Rupak Mukherjee2, Laura E Hollinger3

  • 1College of Medicine, Medical University of South Carolina, 10 McClennan Banks Drive, SJCH 2190/MSC 918, Charleston, SC, 29425, USA. hollingl@musc.edu.

Pediatric Surgery International
|May 20, 2022
PubMed

Insights

Complications during extracorporeal life support (ECLS) increase mortality risk and prolong support duration. Addressing these complications is crucial for improving patient outcomes in ECLS.

Area of Science:

  • Pediatric critical care medicine
  • Cardiovascular research
  • Biomedical engineering

Background:

  • Extracorporeal life support (ECLS) is a vital treatment for critically ill neonates and children.
  • Understanding factors influencing ECLS outcomes is essential for optimizing patient care.
  • Complication accrual is a significant concern during ECLS, but its impact on mortality requires further investigation.

Purpose of the Study:

  • To test the hypothesis that complication accrual during pediatric extracorporeal life support (ECLS) increases mortality.
  • To determine if complications impact survival irrespective of the indication for ECLS.
  • To identify factors associated with complication development and their effect on ECLS outcomes.

Main Methods:

  • Prospective collection of Extracorporeal Life Support Organization (ELSO) registry data for neonatal and pediatric patients.
  • Stratification of patients based on the presence or absence of complications (excluding renal replacement therapy).
  • Survival analysis using Cox proportional hazard regression to assess the association between complications and mortality.

Main Results:

  • Overall survival to discharge was 66% among 114 patients.
  • 54% of patients experienced a total of 149 complications, with 29% being mechanical.
  • Complications were associated with longer ECLS duration (168 vs. 86 hours) and decreased survival (p=0.003).

Conclusions:

  • Complications encountered during ECLS are independently associated with decreased survival.
  • The presence of complications predicts poorer outcomes, regardless of pre-ECLS variables.
  • A multidisciplinary ECLS team approach targeting complication reduction is recommended to improve patient survival.
Abstract

Keywords:
ComplicationsExtracorporeal life supportExtracorporeal membrane oxygenationMortalityNeonatalPediatric

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