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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Patient Characteristics and Extracorporeal Membrane Oxygenation Outcomes at Nelson Mandela Children's Hospital: A
Jessica Price1,2, Shannon Cawood1,3, Krubin Naidoo4
1From the Department of Paediatrics and Child Health, University of Witwatersrand, Johannesburg, South Africa.
Insights
Extracorporeal membrane oxygenation (ECMO) in South Africa treated 57 children, with a 54.4% mortality rate. Despite challenges in resource-limited settings, ECMO can be successfully offered, with fluid overload and infection being common morbidities.
Area of Science:
- Pediatric Critical Care
- Cardiopulmonary Support
- Resource-Limited Healthcare
Background:
- Extracorporporeal membrane oxygenation (ECMO) provides vital cardiopulmonary support.
- Data on pediatric ECMO outcomes in resource-limited settings are scarce.
- Understanding patient characteristics and outcomes is crucial for optimizing care.
Purpose of the Study:
- To describe patient demographics, mortality, and morbidity in children undergoing ECMO.
- To evaluate ECMO effectiveness in a South African pediatric center.
- To identify factors influencing outcomes in a resource-limited context.
Main Methods:
- Retrospective analysis of 57 pediatric patients treated with ECMO from 2018-2023.
- Data collected on patient age, ECMO type (VA-ECMO, VV-ECMO), indications, and outcomes.
- Statistical analysis to assess associations between patient characteristics and mortality.
Main Results:
- Overall mortality was 54.4%.
- Respiratory indications (60%) were most common, followed by congenital cardiac lesions (33%).
- Fluid overload (92%) and infection (84%) were the most frequent morbidities; neurologic sequelae occurred in 40%.
Conclusions:
- ECMO can be successfully implemented in resource-limited settings.
- Patient age, sex, nutrition, and HIV status did not significantly impact mortality.
- Further research on prognostic factors specific to these populations is warranted.
Abstract:
This study aimed to describe patient characteristics, mortality, and morbidity outcomes in children at a South African extracorporeal membrane oxygenation (ECMO) center. Fifty-seven patients required ECMO from 2018 to 2023 at the Nelson Mandela Children's Hospital in Johannesburg; eight neonates (14%), 35 infants (61.4%) 29 days-1 year, 11 (19%) aged 1-5 years, and three (5%) over 5 years. Fifty patients received venoarterial (VA)-ECMO (88%), six (11%) received venovenous (VV)-ECMO, and one patient (2%) was converted from VV- to VA-ECMO. Nineteen (33%) required ECMO for an underlying congenital cardiac lesion; 34 (60%) for respiratory indications and four (7%) post-thoracic surgery. The overall mortality rate was 54.4% with no significant difference in survival between patients on VA-ECMO compared with VV-ECMO. Differences in patient age, sex, nutrition, and human immunodeficiency virus (HIV) status were not significantly associated with mortality. The median length of ECMO run was 14 days, with significantly longer runs in respiratory cases. The most common patient morbidities experienced on ECMO were fluid overload (92%) and infection (84%). Neurologic sequelae occurred in 40% of cases. Mechanical complications were rare. Our findings highlight that ECMO can be offered successfully despite challenges experienced in resource-limited settings. Future research should focus on specific prognostic factors of relevance to our populations.
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