Extracorporeal membrane oxygenation: Support for overwhelming pulmonary failure in the pediatric population. Collective experience from the Extracorporeal Life Support Organization

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 FlO z .97 ± .07 and a mean airway pressure (MAP) 23.6 ± 8 cm H 2O used to achieve PaO 2 of 50 ± 39 and PaCO 2 51 ± 22 mm Hg. The MAP was significantly higher in nonsurvivors versus survivors (25.3 ± 8.7 v 22.0 ± 7.1 cm H 2O, 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). Mechanical complications occurred in 50% of the patients with a rate of 0.68 ± 0.81 mechanical complications per patient. Survivors had fewer mechanical complications than nonsurvivors (0.5 ± 0.65 v 0.84 ± 0.91 per patient, P < .001). Seventy-nine percent of the patients had a medical complication with an incidence of 2.4 ± 2.1 per patient. Survivors had fewer medical complications per patient than nonsurvivors (1.6 ± 1.6 v 3.2 ± 2.2 per patient, P < .001). Options for the future of ECMO for pediatric pulmonary failure are discussed.