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Extracorporeal membrane oxygenation for refractory septic shock in children
Objective:
To review demographic data and outcome of children who received extracorporeal membrane oxygenation (ECMO) for refractory septic shock.
Method:
Review of medical charts of nine children receiving ECMO for culture-proven refractory septic shock treated in a multidisciplinary pediatric intensive care unit.
Results:
Median age was 12 years and median weight was 45 kg. Median inotrope requirements (micrograms/kg per minute) before ECMO were dopamine, 15; dobutamine, 12.5; epinephrine, 4; and norepinephrine, 3.5. Four children received two inotropes concurrently, and five received three or more. All nine patients had severe respiratory failure; eight had evidence of other organ system dysfunction, with six having five or more organ system dysfunctions. Median PRISM score was 27. Median duration of ECMO was 137 hours. Within 24 hours of starting ECMO, 7 of 9 children had all inotropes stopped. Four patients died and five survived, all of whom are leading normal lives.
Conclusion:
In this small group of children with probably fatal septic shock, ECMO was successfully supported the circulation and 5 of the 9 children survived. We suggest that septic shock should not be considered a contraindication to ECMO.