Abstract PCCLB-52: Extracorporeal membrane oxygenation support for children: analysis of a pediatric intensive care unit experience in northern taiwan

Abstract

Background Extracorporeal membrane oxygenation (ECMO) has been well-known as an important supportive technique in patients with cardiopulmonary failure. However, few studies have been conducted in pediatric patients. The aim of this study is to analyze the experience of ECMO use in pediatric intensive care unit of a single medical center in northern Taiwan. Methods We conducted a retrospective chart review of pediatric patients who were placed on ECMO at pediatric intensive care unit of Chang Gung Memorial Hospital between 2005 and 2017. Results We identified 54 children younger than 18 years old on ECMO support with total 56 runs. Male sex was 26 (46.4%). Of these, 2 patients who received ECMO for venovenous (VV) mode initially and shifted to venoarterial (VA) mode within 72 hours due to cardiopulmonary collapse were analyzed as supporting by VA mode only. A patient who received VA mode twice after over 6 months of spontaneous circulation was counted as supporting by VA mode twice. Another patient who received VA mode initially and then shifted to VV mode due to regain of cardiac function was included as supporting by both modes. There were 43 (76.79%) and 13 (23.21%) runs for venoarterial (VA) mode and venovenous (VV) mode, respectively. Mean duration of on ECMO for VA mode was 194.84 hours and for VV mode was 188.85 hours. The most common reason for VA mode was myocarditis due to virus infection (62.79%, 27 of 43) and for VV mode was acute respiratory distress syndrome (84.62%, 11 of 13). The total successful weaning rate was 64.3% (36 of 56) with 58.1% (25 of 43) for VA mode and 84.6% (11 of 13) for VV mode. However, the overall survival to discharge rate was 50% (28 of 56). Major complications were divided into 3 categories which were central nervous system (28.57%, 16 of 56), vascular (23.21%, 13 of 56) and renal injuries (57.14%, 32 of 56). The complication rate for survivals with VA mode was 65% (13 of 20) and with VV mode was 75% (6 of 8). Among survivals free from complications (32.14 %, 9 of 28), the duration of ECMO support was lesser than those with complications (150.11 versus 161.84 hours). Conclusions Extracorporeal membrane oxygenation could be a life-saving technique for children with profound cardiovascular or respiratory failure despite complications of multiple vital organs. The duration of on ECMO could be a predictor of major complications for survivals.