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Children with Near-Fatal Asthma: The Use of Inhaled Volatile Anesthetics and Extracorporeal Membrane Oxygenation

Chasity M Custer1, Erika R O'Neil2, Janaki Paskaradevan3

  • 1Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.

Pediatric Allergy, Immunology, and Pulmonology
|December 20, 2022
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) is a safe and effective treatment for near-fatal asthma. ECMO may reduce bronchodilator medication exposure compared to inhaled volatile anesthetics in severe asthma cases.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Medicine
  • Cardiopulmonary Support

Background:

  • Near-fatal asthma requires advanced respiratory support when refractory to maximal medical therapy.
  • Extracorporeal membrane oxygenation (ECMO) is an established option for severe respiratory failure.
  • Isoflurane has been used as an alternative for severe asthma exacerbations.

Purpose of the Study:

  • To compare outcomes and medication usage in pediatric patients with near-fatal asthma treated with ECMO versus isoflurane.
  • To evaluate the safety and efficacy of ECMO in refractory asthma.
  • To assess bronchodilator exposure in asthma patients managed with ECMO versus isoflurane.

Main Methods:

  • Retrospective study of pediatric patients with asthma admitted to Texas Children's Hospital PICU from 2012-2020.
  • Comparison of demographics, medication use (albuterol, terbutaline), and complications between ECMO (n=12) and isoflurane (n=8) groups.
  • Analysis of patient survival to discharge and duration of bronchodilator administration.

Main Results:

  • All patients in both groups survived to discharge.
  • ECMO group received significantly shorter durations of albuterol (12 vs. 104 hours, P=0.0002) and terbutaline (13.3 vs. 31.5 hours, P=0.0250).
  • No significant differences in complication rates were observed between the ECMO and isoflurane groups.

Conclusions:

  • ECMO represents a viable and safe support strategy for pediatric patients experiencing near-fatal asthma.
  • ECMO may be associated with reduced exposure to bronchodilator medications compared to inhaled volatile anesthetics in severe asthma.
  • Further research may explore optimal timing and selection criteria for ECMO in refractory asthma exacerbations.

Keywords:
extracorporeal membrane oxygenationintensive care unitspediatricsocial determinants of healthstatus asthmaticus

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