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Published on: November 4, 2010
Pediatric extracorporeal life support for refractory status asthmaticus: ELSO Registry trends from the past decade
Anuradha Setlur1,2, Marisa Meyer1, Jennifer S Nelson3,4
1Critical Care, Nemours Children's Health Delaware, Wilmington, Delaware, USA.
Insights
Extracorporeal life support (ECLS) is a rare but effective rescue therapy for pediatric status asthmaticus (SA). Experience has improved ECLS safety, reducing complications while maintaining good survival rates.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Cardiopulmonary Support
Background:
- Extracorporeal life support (ECLS) for status asthmaticus (SA) is infrequently utilized.
- Increased safety and clinical experience may lead to greater adoption of ECLS for SA.
Approach:
- A retrospective review of pediatric patients (<18 years) with SA requiring ECLS was conducted from 1998-2019.
- Data from the Extracorporeal Life Support Organization (ELSO) Registry and Nemours Children's Health (NCH) system were analyzed.
- Patient characteristics, pre-ECLS treatments, clinical data, complications, and survival were compared between early (1988-2008) and late (2009-2019) eras.
Key Points:
- Hospital survival remained high (89% vs. 88%) between eras.
- Intubation to cannulation time significantly decreased in the later era (10 hours vs. 20 hours).
- Complication rates, including hemorrhagic and mechanical issues, were significantly lower in the late era.
Conclusions:
- ECLS serves as a valuable rescue therapy for pediatric status asthmaticus.
- Improved ECLS safety and reduced complication rates are evident with increased experience.
- Pre-ECLS cardiac arrest is a potential risk factor for neurological injury and impacts survival.
Background:
Extracorporeal life support (ECLS) for status asthmaticus (SA) is rare. Increased safety and experience may increase utilization of ECLS for SA.
Methods:
We reviewed pediatric (<18 years old) patients requiring ECLS for SA between 1998 and 2019 within the Extracorporeal Life Support Organization (ELSO) Registry and Nemours Children's Health (NCH) system. We compared patient characteristics, pre-ECLS medications, clinical data, complications, and survival to discharge between Early (1988-2008) and Late (2009-2019) eras.
Results:
From the ELSO Registry, we identified 173 children, 53 in Early and 120 in Late eras, with primary diagnosis of SA. Pre-ECLS hypercarbic respiratory failure was similar between eras (median pH 7.0 and pCO2 111 mm Hg). Venovenous mode (79% vs. 82%), median ECLS time (116 vs. 99 h), time to extubation (53 vs. 62 h), and hospital survival (89% vs. 88%) also remained similar. Intubation to cannulation time significantly decreased (20 vs. 10 h, p = 0.01). ECLS without complication occurred more in the Late era (19% vs. 39%, p < 0.01), with decreased hemorrhagic (24% vs. 12%, p = 0.05) and noncannula-related mechanical (19% vs. 6%, p = 0.008) complications. Within NCH, we identified six Late era patients. Pre-ECLS medication favored intravenous beta agonists, bronchodilators, magnesium sulfate, and steroids. One patient died from neurological complications following pre-ECLS cardiac arrest.
Conclusions:
Collective experience supports ECLS as a rescue therapy for pediatric SA. Survival to discharge remains good, and complication rates have improved. Pre-ECLS cardiac arrest may potentiate neurologic injury and impact survival. Further study is needed to evaluate causal relationships between complications and outcomes.
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