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Extracorporeal life support for severe pediatric respiratory failure: an updated experience 1991-1993
F W Moler1, J R Custer, R H Bartlett
1Department of Pediatrics, University of Michigan Hospitals, Ann Arbor 48109-0718.
Insights
Extracorporeal life support (ECLS) improved survival rates for children with acute respiratory failure, with recent outcomes showing an 88% survival rate. This advanced pulmonary rescue therapy offers significant hope for critically ill pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Support
- Respiratory Failure Management
Background:
- Acute respiratory failure in children presents a significant challenge in pediatric critical care.
- Extracorporeal life support (ECLS) has emerged as a vital intervention for severe, life-threatening respiratory failure.
- Previous ECLS outcomes in pediatric populations necessitate ongoing evaluation to track improvements in survival rates.
Purpose of the Study:
- To evaluate recent outcomes of pediatric patients treated with ECLS for acute respiratory failure.
- To compare current survival rates with historical data to identify changes in treatment efficacy.
- To assess the impact of ECLS as a pulmonary rescue therapy in a pediatric tertiary referral center.
Main Methods:
- A historic and prospective cohort study was conducted at a tertiary pediatric referral center.
- Data were collected on 25 non-neonatal pediatric patients managed with ECLS for severe respiratory failure between 1991 and 1993.
- Patient characteristics, pre-ECLS ventilation parameters, and ECLS duration were analyzed, with survival rates compared to a previous cohort.
Main Results:
- The recent cohort of 25 pediatric patients achieved an 88% survival rate (22/25) following ECLS treatment.
- This represents a statistically significant improvement compared to the previously reported 58% survival rate (p < 0.05).
- Infants under 1 year of age demonstrated a 100% survival rate in the overall experience.
Conclusions:
- ECLS is an evolving and effective pulmonary rescue therapy for pediatric acute respiratory failure, demonstrating an 88% survival rate in recent cases.
- The observed improvement suggests that current patient selection and management strategies are highly effective.
- Further significant improvements in survival rates may be limited, particularly for the youngest patients, highlighting the need for continued refinement of ECLS protocols.
Objective:
The purpose of this study was to examine our recent experience with children who had acute respiratory failure managed with extracorporeal life support (ECLS) from 1991 to 1993, to determine whether a change in survival rate had occurred in comparison with our previous experience.
Design:
Historic and prospective cohort study.
Setting:
A tertiary pediatric referral center.
Patients:
All non-neonatal pediatric patients treated with ECLS for severe, life-threatening respiratory failure were examined. Overall, 25 patients have been managed with this life-support technique in the past 28 months. Eighty-four percent (21/25) were transferred to our medical center because of failure of conventional mechanical ventilation therapy. Descriptive data of the recent cohort were as follows (mean +/- SD): age 60 +/- 75 months, weight 23.6 +/- 24.8 kg, and male gender 44%. Duration of intubation before ECLS was 5.8 +/- 2.7 days. Arterial blood gas values and ventilator settings immediately before ECLS were as follows: fraction of inspired oxygen, 0.98 +/- 0.08; mean airway pressure, 21.6 +/- 6.2 cm H2O; peak inspiratory pressure, 45.5 +/- 9.6 cm H2O; positive end-expiratory pressure, 11.0 +/- 4.3 cm H2O; partial pressure of oxygen (arterial), 56 +/- 20 mm Hg (7.4 +/- 2.7 kilopascals); partial pressure of carbon dioxide (arterial), 46 +/- 17 mm Hg (6.1 +/- 2.3 kPa); and estimated alveolar-arterial oxygen tension difference, 572 +/- 81 mm Hg (76.3 +/- 10.8 kPa). Mean duration of ECLS was 373 +/- 259 hours. Of 25 recently treated patients, 22 (88%) survived their life-threatening respiratory illness to be discharged home; this represented a statistically improved survival rate in comparison with the 58% survival rate previously reported by us for similar patients (p < 0.05). Comparisons of arterial blood gas and mechanical ventilation-related variables measured 24 hours before and again immediately before bypass were similar in the two cohorts with the exception of higher mean partial pressure of carbon dioxide (arterial) 24 hours before bypass in the recent treatment group. For our entire experience, younger age groups had greater survival rates; 100% of infants less than 1 year of age survived.
Conclusions:
Treatment with ECLS is an evolving pulmonary rescue therapy with an 88% survival rate in our recent experience. The survival rate has improved to levels that may not greatly improve in the near future, especially for patients less than 1 year of age. Better patient selection or improved management strategies or both may be responsible for the improved patient outcome.