Why do children not survive extracorporeal membrane oxygenation?

Area of Science:

• Pediatric Critical Care Medicine
• Cardiopulmonary Support
• Medical Technology Assessment

Background:

• Extracorporeal membrane oxygenation (ECMO) use is rising in critically ill children, including those with complex comorbidities.
• Understanding the specific reasons why children do not survive ECMO is essential for improving outcomes.
• This study addresses a gap in knowledge regarding mortality in pediatric ECMO patients.

Purpose of the Study:

• To describe the characteristics and causes of death in children receiving ECMO.
• To compare mortality rates in pediatric ECMO patients with high-risk comorbidities.
• To evaluate trends in ECMO survival over a ten-year period.

Main Methods:

• Retrospective analysis of 428 children (<18 years) who received ECMO between 2011 and 2020.
• Categorization of outcomes: death within 48 hours, death after 48 hours, and hospital discharge survival.
• Classification of reasons for ECMO withdrawal in non-survivors, including irrecoverable original condition and poor neurological prognosis.

Main Results:

• Overall hospital survival to discharge was 67%, with no significant change over the decade.
• The majority of deaths occurred after ECMO withdrawal due to irrecoverable disease (39%) or poor prognosis (32% neurological, 18% complex conditions).
• Children with high-risk comorbidities like genetic syndromes (58% mortality) and malignancy (0% survival) had significantly lower survival rates.

Conclusions:

• In pediatric ECMO, death is often associated with elective withdrawal of support due to irrecoverable disease or poor prognosis.
• Despite challenges, children with high-risk comorbidities demonstrate a potential for survival with ECMO therapy.
• This study supports ECMO as a viable therapeutic option for select critically ill children, even those with complex conditions.