Outcome of Severe Adenoviral Respiratory Infection Supported With Extracorporeal Membrane Oxygenation: A Multicenter PICU Study From Colombia (2018-2022)
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Published on: August 22, 2020
Lorena Acevedo1,2,3,4, Jaime Fernández-Sarmiento1,3, Hernando Mulett1,2
1Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
Insights
Pediatric patients with severe adenoviral infections requiring extracorporeal membrane oxygenation (ECMO) support showed similar survival rates compared to those with other viral infections. Key mortality factors included pre-ECMO acidosis, high Vasoactive-Inotropic Score, and delayed ECMO initiation.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Cardiopulmonary Support
Background:
- Severe respiratory infections in children can necessitate extracorporeal membrane oxygenation (ECMO).
- Adenoviral infections are a significant cause of pediatric respiratory illness.
- Comparative outcomes for adenoviral vs. other viral infections requiring ECMO are not well-defined.
Purpose of the Study:
- To compare survival, clinical characteristics, complications, and ECMO duration in pediatric patients with severe adenoviral respiratory infections versus other viral respiratory infections.
- Identify factors associated with mortality in pediatric patients requiring ECMO for viral respiratory infections.
Main Methods:
- Multicenter, retrospective observational study conducted in seven Pediatric Intensive Care Units (PICUs) in Colombia.
- Included pediatric patients (1 month to 18 years) receiving ECMO support between January 2018 and December 2022.
- Primary outcome was 28-day survival, comparing adenoviral infection group with other viral infection groups.
Main Results:
- 205 patients were analyzed: 39% (80) with adenoviral infections and 61% (125) with other viral infections.
- No significant difference in 28-day survival between adenoviral (77.6%) and other viral (73.6%) infection groups (p=0.513).
- Independent mortality predictors included pre-ECMO acidosis, high Vasoactive-Inotropic Score (VIS > 15), and delayed ECMO cannulation (>13 hours). Hemorrhagic complications occurred in 40% of patients.
Conclusions:
- Severe adenoviral infections requiring ECMO support did not show increased mortality compared to other viral infections in pediatric patients.
- Pre-ECMO acidosis, high VIS, and delayed ECMO initiation are critical factors influencing mortality.
- Hemorrhagic complications are common, with increased risk associated with younger age, prior SARS-CoV-2 infection, prolonged ECMO, and renal replacement therapy.
Objectives:
To compare survival, clinical characteristics, complications, and duration of extracorporeal membrane oxygenation (ECMO) support in pediatric patients with severe adenoviral respiratory infections vs. those with other viral respiratory infections.
Design:
Multicenter, retrospective observational study.
Setting:
Seven PICUs in Colombia, South America.
Patients:
Children 1 month to 18 years old who received ECMO support between January 2018 and December 2022. The primary outcome was survival in children with severe adenoviral infection requiring ECMO, compared with those with ECMO due to other viral respiratory infections.
Interventions:
None.
Measurements And Main Results:
A total of 205 patients were included; 39% (80/205) had adenoviral infections and 61% (125/205) had other viral respiratory infections. We failed to find an association between the adenovirus group, vs. the nonadenovirus group, and 28-day survival (62/80 [77.6%] vs. 92/125 [73.6%]; p = 0.513). Independent pre-ECMO factors associated with greater odds (adjusted odds ratio [aOR], 95% CI) of mortality across both groups included Vasoactive-Inotropic Score (VIS > 15; aOR, 3.18 [95% CI, 1.08-7.45]), arterial pH less than 7.2 (aOR, 3.79 [95% CI, 1.75-5.52]), and time from meeting ECMO criteria to actual cannulation greater than 13 hours (aOR, 4.04 [95% CI, 1.72-7.21]). Hemorrhagic complications occurred in 81 of 205 (40%) of all patients, and CNS hemorrhage and cannulation site bleeding were the most common locations of bleeding. Greater odds of hemorrhagic complication were associated with age younger than 36 months, previous severe acute respiratory syndrome coronavirus 2 infection, ECMO duration greater than 10 days, and use of continuous renal replacement therapy during ECMO.
Conclusions:
In pediatric patients with severe adenoviral infections requiring ECMO support, compared with those with other viral infections requiring ECMO, we failed to identify associated greater odds of mortality. Key factors associated with greater odds of mortality included pre-ECMO acidosis, high VIS, and greater than 13-hour delay in initiating ECMO support.
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