Abstract
The effect of positive fluid balance (FB) on extracorporeal membrane oxygenation (ECMO) outcomes in pediatric patients remains unknown. We sought to evaluate if positive FB in pediatric intensive care unit (PICU) patients with respiratory and/or cardiac failure necessitating ECMO was associated with increased morbidity or mortality. This was a multicenter retrospective cohort study of data from the deidentified PEDiatric ECMO Outcomes Registry (PEDECOR). Patients entered into the database from 2014 to 2017, who received ECMO support, were included. A total of 168 subjects met the study criteria. Univariate analysis showed no significant difference in total FB on ECMO days 1–5 between survivors and non-survivors [median 90 ml/kg (IQR 18–208.5) for survivors vs. median 139.7 ml/kg (IQR 11.2–300.6) for non-survivors, p = 0.334]. There was also no difference in total FB on ECMO days 1–5 in patients with no change in functional outcome as reflected by the Pediatric Outcome Performance Category (POPC) score vs. those who had worsening in POPC score ≥2 at hospital discharge [median 98 ml/kg (IQR 18–267) vs. median 130 ml/kg (IQR 13–252), p = 0.91]. Subjects that required 50 ml/kg or more of blood products over the initial 5 days of ECMO support had an increased rate of mortality with an odds ratio of 5.8 (95% confidence interval of 2.7–12.3; p = 0.048). Our study showed no association of the noted FB with survival after ECMO cannulation. This FB trend was also not associated with POPC at hospital discharge, MV duration, or ECMO duration. The amount of blood product administered was found to be a significant predictor of mortality.
Highlights
Extracorporeal membrane oxygenation (ECMO) is considered an effective rescue therapy for severe respiratory or cardiac failure [1,2,3]
The Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network supported these findings in 2012 with a retrospective study of children with acute lung injury (ALI) that demonstrated an association of increasing positive fluid balance (FB) by day 3 with decreased ventilator-free days (VFD) [22]
Our objective was to evaluate if daily positive FB in pediatric intensive care unit (PICU) patients on ECMO was associated with increased morbidity or mortality
Summary
Extracorporeal membrane oxygenation (ECMO) is considered an effective rescue therapy for severe respiratory or cardiac failure [1,2,3]. In 2006, the ARDS network published results of a randomized clinical trial comparing conservative vs liberal fluid strategy in adult patients with ALI [20]. The results of this trial demonstrated that a conservative fluid management strategy resulted in improved lung function, fewer mechanical ventilation (MV) days, and shorter ICU length of stay [20]. The Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network supported these findings in 2012 with a retrospective study of children with ALI that demonstrated an association of increasing positive FB by day 3 with decreased ventilator-free days (VFD) [22]
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