706: OUTCOME COMPARISON OF INHALED ANESTHETICS VERSUS ECMO IN CHILDREN WITH NEAR-FATAL ASTHMA

Abstract

Introduction: Extracorporeal Membrane Oxygenation (ECMO) and Inhaled Anesthetics (IA) are considered in the management of Near-Fatal Asthma (NFA) refractory to conventional therapy. We sought to compare these two modalities in children. Methods: This is a retrospective study using the Virtual Pediatric Systems Database, (VPS, LLC). We included patients < 18 years of age with NFA treated with IA and/or ECMO between January 2010 and December 2020. Primary outcome was survival to hospital discharge. Results: A total of 221 patients were included in the study; 149 (67%) received only ECMO, 62 (28%) received only IA and 10 (5%) patients received both. There was no difference in age, PIM3, PRISM3, PELOD scores, pre-intervention pH or pCO2 between the ECMO and lA groups. The ECMO group had lower pre-intervention PaO2 (60 vs 78mmHg, p < 0.001) and higher utilization of high frequency oscillatory ventilation compared to the IA cohort. Pre intervention heliox was used more frequently in the lA group (p < 0.001). There was no difference in survival to hospital discharge; 128/149 (86%) in ECMO and 57/62 (92%) in IA (p=0.38) cohorts. The ECMO group had longer duration of intervention (5 vs 1.3 days, p< 0.001), more frequent mid intervention cardiac arrest (7% vs 2%, p= 0.04), longer ICU length of stay (LOS) (13 vs 7 days p< 0.001) and required more bronchoscopies (34% vs 11% p< 0.001). Post-intervention mechanical ventilation was similar among survivors (p=0.38). Conclusions: In our study, ECMO and IA had comparable survival to hospital discharge. However, ECMO was associated with higher risk of complications and ICU LOS.