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Published on: August 15, 2022
Extracorporeal membrane oxygenation for pediatric respiratory failure: five-year experience at the University of
A Morton1, H Dalton, P Kochanek
1Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh, PA.
Insights
Extracorporeal membrane oxygenation (ECMO) offers a rational therapy for pediatric respiratory failure. Favorable prognostic indicators include lung function recovery, while persistent airleak suggests a poorer outcome.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary support
Background:
- Pediatric respiratory failure poses a significant challenge in critical care settings.
- Extracorporeal membrane oxygenation (ECMO) is an advanced life support technique for severe respiratory and cardiac failure.
Purpose of the Study:
- To detail the causes, severity, and outcomes of pediatric respiratory failure treated with ECMO.
- To identify predictors of mortality in pediatric ECMO patients.
- To compare outcomes with conventional management strategies.
Main Methods:
- A case series design was employed.
- Data were collected from 28 pediatric patients (3 weeks to 20 years) treated with ECMO for respiratory failure between 1985 and 1991.
- Patients were managed in a tertiary care pediatric hospital's intensive care unit.
Main Results:
- Survival rate was 46% (13 out of 28 patients).
- Common diagnoses included adult respiratory distress syndrome and nonspecific pneumonitis.
- Nonsurvivors showed a higher incidence of persistent airleak and poorer response to lung reexpansion maneuvers compared to survivors.
Conclusions:
- ECMO is a viable treatment for pediatric respiratory failure unresponsive to conventional management.
- Early lung function recovery within the first week of ECMO may indicate a positive prognosis.
- Persistent airleak is associated with increased mortality.
Objectives:
To describe the etiology, respiratory severity of illness, and outcome in patients with pediatric respiratory failure who were treated with extracorporeal membrane oxygenation (ECMO). To identify predictors of death, and to compare our morbidity and mortality rates with those rates of a previously reported series of patients with pediatric respiratory failure managed conventionally.
Design:
Survey, case series.
Setting:
Intensive care unit in a tertiary care pediatric hospital.
Patients:
Twenty-eight pediatric patients (3 wks to 20 yrs of age) who underwent ECMO for pediatric respiratory failure between 1985 and 1991.
Measurements And Main Results:
Thirteen (46%) of the 28 patients survived. The most common diagnoses were adult respiratory distress syndrome and nonspecific pneumonitis. Multiple organ system failure occurred in only four (14%) patients; most patients died of respiratory failure. The occurrence of persistent airleak during ECMO was significantly greater in nonsurvivors than in survivors. Furthermore, nonsurvivors had significantly less response to lung reexpansion maneuvers compared with survivors, as measured by a calculated compliance index (effective tidal volume/mean airway pressure x 100). The mortality rate was comparable with those rates of other published studies of conventionally managed and ECMO-treated patients with pediatric respiratory failure. Moreover, our patients appeared to exhibit more severe respiratory failure at the start of ECMO than those patients in other studies.
Conclusions:
ECMO appears to be a rational therapy for patients with pediatric respiratory failure who are likely to die with continued conventional management. Recovery of lung function by the end of the first week of ECMO may be a favorable prognostic indicator. Persistent airleak may be a nonfavorable prognostic indicator.
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