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Association between mechanical ventilation parameters and mortality in children with respiratory failure on ECMO: a

Jaime Fernandez-Sarmiento1, Maria Camila Perez1, Juan David Bustos1

  • 1Department of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.

Frontiers in Pediatrics
|January 31, 2024
PubMed

Insights

Optimal mechanical ventilation in children undergoing extracorporeal membrane oxygenation (ECMO) is crucial. High plateau pressure, high driving pressure, and very low tidal volume ventilation are linked to increased mortality in pediatric refractory respiratory failure patients on ECMO.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Extracorporeal Life Support

Background:

  • Refractory respiratory failure (RF) in children often necessitates extracorporeal membrane oxygenation (ECMO) as a life-saving therapy.
  • Mechanical ventilation during ECMO aims to minimize lung injury, but optimal parameters remain unclear.
  • Ventilatory management strategies significantly influence outcomes in pediatric ECMO patients.

Purpose of the Study:

  • To investigate the association between mechanical ventilation parameters and in-hospital mortality in pediatric patients with RF supported by ECMO.
  • To identify specific ventilatory settings that correlate with increased mortality risk.
  • To inform best practices for mechanical ventilation in critically ill children on ECMO.

Main Methods:

  • A systematic literature search was conducted across major databases (PubMed/MEDLINE, Embase, Cochrane, Google Scholar) from January 2013 to May 2022.
  • Six relevant studies involving pediatric ECMO patients with RF were included in the meta-analysis.
  • Risk of bias and heterogeneity were assessed; sensitivity and subgroup analyses were performed using a random-effects model.

Main Results:

  • Mechanical ventilation with very low tidal volume (<4 mL/kg) was associated with significantly higher mortality (OR: 4.70).
  • Elevated plateau pressure and driving pressure were also linked to increased mortality.
  • Survival rates in the included 28-day studies were 69%; survivors experienced less multiple organ failure.

Conclusions:

  • High plateau pressures, high driving pressures, and very low tidal volume ventilation are critical mechanical ventilation parameters associated with increased mortality in pediatric ECMO patients.
  • Inspired fraction of oxygen and end-expiratory pressure did not show a significant association with mortality.
  • These findings highlight the importance of careful ventilator management during ECMO for pediatric refractory respiratory failure.
Abstract

Keywords:
ARDSECMOchildrenmechanical ventilationmortalitypneumoniarespiratory failure

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