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Pediatric Extracorporeal Membrane Oxygenation in Korea: A Multicenter Retrospective Study on Utilization and Outcomes
Yu Hyeon Choi1, Won Kyoung Jhang2, Seong Jong Park2
1Department of Pediatrics, Seoul Medical Center, Seoul, Korea.
Insights
Extracorporeal membrane oxygenation (ECMO) in Korean children shows improving survival rates, particularly for post-cardiotomy cases. However, overall pediatric ECMO outcomes still require further improvement to match global standards.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Respiratory Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) use in critically ill children has risen over the past decade.
- ECMO is associated with improved outcomes in pediatric critical care.
- Evaluating the current status of pediatric ECMO in Korea is crucial.
Purpose of the Study:
- To assess the volume and trends of pediatric ECMO utilization in Korea.
- To analyze survival rates across different diagnostic indications for pediatric ECMO.
- To compare ECMO data between two distinct time periods (2012-2016 and 2017-2021).
Main Methods:
- A retrospective multicenter study analyzing 1065 ECMO runs in 1032 pediatric patients.
- Data collected from 14 Korean hospitals between January 2012 and December 2021.
- Comparison of four diagnostic categories (neonatal respiratory, pediatric respiratory, post-cardiotomy, cardiac-medical) across two 5-year periods.
Main Results:
- The annual number of pediatric ECMO cases remained stable over 10 years.
- Post-cardiotomy was the most frequent indication (42.4%), followed by cardiac-medical (31.8%).
- Overall survival increased significantly from 38.2% to 47.1% (P=0.004), with notable improvement in post-cardiotomy cases (30-45%, P=0.002).
- Higher mortality was associated with neonates, dialysis, extracorporeal cardiopulmonary resuscitation, and immunocompromised status in pediatric respiratory ECMO.
Conclusions:
- Pediatric ECMO in Korea shows a steady increase in overall survival.
- Survival rates vary significantly by diagnostic indication.
- Despite improvements, pediatric ECMO outcomes in Korea remain suboptimal compared to global benchmarks, necessitating further efforts.
Background:
Over the last decade, extracorporeal membrane oxygenation (ECMO) use in critically ill children has increased and is associated with favorable outcomes. Our study aims to evaluate the current status of pediatric ECMO in Korea, with a specific focus on its volume and changes in survival rates based on diagnostic indications.
Methods:
This multicenter study retrospectively analyzed the indications and outcomes of pediatric ECMO over 10 years in patients at 14 hospitals in Korea from January 2012 to December 2021. Four diagnostic categories (neonatal respiratory, pediatric respiratory, post-cardiotomy, and cardiac-medical) and trends were compared between periods 1 (2012-2016) and 2 (2017-2021).
Results:
Overall, 1065 ECMO runs were performed on 1032 patients, with the annual number of cases remaining unchanged over the 10 years. ECMO was most frequently used for post-cardiotomy (42.4%), cardiac-medical (31.8%), pediatric respiratory (17.5%), and neonatal respiratory (8.2%) cases. A 3.7% increase and 6.1% decrease in pediatric respiratory and post-cardiotomy cases, respectively, were noted between periods 1 and 2. Among the four groups, the cardiac-medical group had the highest survival rate (51.2%), followed by the pediatric respiratory (46.4%), post-cardiotomy (36.5%), and neonatal respiratory (29.4%) groups. A consistent improvement was noted in patient survival over the 10 years, with a significant increase between the two periods from 38.2% to 47.1% (P = 0.004). Improvement in survival was evident in post-cardiotomy cases (30-45%, P = 0.002). Significant associations with mortality were observed in neonates, patients requiring dialysis, and those treated with extracorporeal cardiopulmonary resuscitation (P < 0.001). In pediatric respiratory ECMO, immunocompromised patients also showed a significant correlation with mortality (P < 0.001).
Conclusion:
Pediatric ECMO demonstrated a steady increase in overall survival in Korea; however, further efforts are needed since the outcomes remain suboptimal compared with global outcomes.
