Clinical Characteristics and Outcomes for Neonates, Infants, and Children Referred to a Regional Pediatric Intensive Care Transport Service for Extracorporeal Membrane Oxygenation.

Abstract

To describe the clinical characteristics and outcomes of referrals for extracorporeal membrane oxygenation to a regional pediatric intensive care transport service, and identify clinical features at initial referral that predict the eventual need for extracorporeal membrane oxygenation. Retrospective analysis of prospectively collected data. Specialist pediatric intensive care transport service based at a large U.K. extracorporeal membrane oxygenation center. All referrals made for potential extracorporeal membrane oxygenation transport between January 2014 and July 2017. None. Demographic and clinical data at the time of referral, referral outcome, and 90-day mortality status were extracted. Univariate and multivariate analyses were used to identify clinical features at initial referral in neonates that predicted the need for extracorporeal membrane oxygenation. Of 253 extracorporeal membrane oxygenation referrals, 203 were included: 64 of 203 received extracorporeal membrane oxygenation (31.5%), 18 were accepted for extracorporeal membrane oxygenation but died before extracorporeal membrane oxygenation could be provided (8.8%), and 121 did not receive extracorporeal membrane oxygenation (59.6%). The transport team mobilized in 136 of 203 referrals (66.9%); conventional transport to an extracorporeal membrane oxygenation center was successful in 127 of 136 (93.4%), while nine of 136 were too unstable to transport. The 90-day mortality for the cohort was 17.7% (36/203). In logistic regression analysis, the odds ratio of requiring extracorporeal membrane oxygenation for diaphragmatic hernia was 12.0 (95% CI, 2.8-52.1) compared to meconium aspiration syndrome. Oxygenation index and Vasoactive-Inotropic Score were independent predictors of the need for extracorporeal membrane oxygenation in neonates. In this large cohort of neonatal and pediatric extracorporeal membrane oxygenation referrals to a pediatric intensive care transport service, a considerable portion of extracorporeal membrane oxygenation referrals (59.6%) continued on conventional management; however, 8.8% of the referrals died before extracorporeal membrane oxygenation could be provided. Earlier referral for extracorporeal membrane oxygenation; targeted referral triage using primary diagnosis, oxygenation index, and Vasoactive-Inotropic Score; and access to mobile extracorporeal membrane oxygenation services and faster mobilization of transport teams are important factors that could improve outcomes.