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Extracorporeal membrane oxygenation: support for overwhelming pulmonary failure in the pediatric population.
P P O'Rourke1, C J Stolar, J B Zwischenberger
1Extracorporeal Life Support Organization, Ann Arbor, MI.
Insights
Extracorporeal membrane oxygenation (ECMO) supported 285 pediatric patients with respiratory failure, achieving a 47% survival rate. Higher mean airway pressure was associated with lower survival in this study of pediatric ECMO use.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Support
- Respiratory Failure Management
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital intervention for severe pediatric respiratory failure.
- Data on its application in children is crucial for refining treatment protocols.
- The Extracorporeal Life Support Organization (ELSO) registry provides a valuable dataset for such analyses.
Purpose of the Study:
- To review the utilization and outcomes of ECMO in pediatric patients with respiratory failure.
- To analyze patient demographics, diagnoses, and treatment parameters.
- To identify factors associated with survival in this cohort.
Main Methods:
- Retrospective review of 285 pediatric patients (14 days to 18 years) treated with ECMO between 1982 and 1991.
- Data collected from 52 ECMO centers, with a focus on 7 high-volume centers.
- Analysis of pre-ECMO ventilatory support, diagnoses, ECMO duration, and complications.
Main Results:
- Overall survival rate was 47% (135/285).
- Common diagnoses included viral pneumonia (32%) and ARDS (28%).
- Higher mean airway pressure (MAP) during mechanical ventilation was significantly associated with non-survival (P < .01).
Conclusions:
- ECMO can be a life-saving therapy for pediatric respiratory failure, but survival rates remain a concern.
- Further research is needed to optimize ECMO criteria and management strategies.
- Standardization of entry criteria and improved understanding of factors influencing outcomes are essential.
Abstract:
Data from the Extracorporeal Life Support Organization (ELSO) regarding the use of extracorporeal membrane oxygenation (ECMO) in pediatric patients with respiratory failure are reviewed. Two hundred eighty-five children between the ages of 14 days and 18 years were supported with ECMO between January 1982 and September 1991. Although these data represent the experience of 52 ECMO centers, seven centers accounted for over 50% of the total. The patients had a mean age of 33 +/- 48 months with a median age of 13 months: 137 (48%) were male and 148 (52%) were female. There were numerous primary pulmonary diagnoses: the two most common were presumed viral pneumonia (32%) and adult respiratory distress syndrome (28%). Entry criteria for ECMO, although poorly defined and specific to each institution, attempted to identify children with an 85% to 100% predicted mortality. The survival rate with ECMO was 47% (135/285). Pre-ECMO mechanical ventilatory support was extreme with an FIO2 .97 +/- .07 and a mean airway pressure (MAP) 23.6 +/- 8 cm H2O used to achieve PaO2 of 50 +/- 39 and PaCO2 51 +/- 22 mm Hg. The MAP was significantly higher in nonsurvivors versus survivors (25.3 +/- 8.7 v 22.0 +/- 7.1 cm H2O, P < .01). The duration of ECMO was 4 hours to 35.5 days with a mean of 245 +/- 165 hours, which is approximately 10 days. Duration for survivors was 222 +/- 151 hours compared with 266 +/- 176 hours for nonsurvivors. ECMO complications are divided into two categories: mechanical (directly related to the ECMO circuit) and medical (patient related).(ABSTRACT TRUNCATED AT 250 WORDS)