Outcomes in children with refractory pneumonia supported with extracorporeal membrane oxygenation

Intensive Care Medicine, 05/07/2012

Smalley N et al. – Survival in children with pneumonia requiring extracorporeal membrane oxygenation (ECMO) has improved over time and is now 90 % in the modern era. Risk factors for death include performing a circuit change and use of continuous renal replacement therapy.

Methods

  • Retrospective study of the ECMO database of a tertiary paediatric intensive care unit and chart review of all patients who were managed with ECMO during their treatment for severe pneumonia over a 23-year period.
  • The main outcome measures were survival to hospital discharge, and ICU and hospital length of stay.
  • The authors compared the groups of culture-positive versus culture-negative pneumonia, venoarterial (VA) versus venovenous (VV) ECMO, community- versus hospital-acquired cases, and cases before and after 2005.

Results

  • Fifty patients had 52 cases of pneumonia managed with ECMO.
  • Community-acquired cases were sicker with higher oxygenation index (41.5±20.5 versus 26.8±17.8; p=0.031) and higher inotrope score [20(5–37.5) versus 7.5(0–18.8); p=0.07].
  • Use of VA compared with VV ECMO was associated with higher inotrope scores [20(10–50) versus 5(0–20); p=0.012].
  • There was a trend towards improved survival in the VV ECMO group (82.4 versus 62.9 %; p=0.15).
  • Since 2005, patients have been older [4.7(1–8) versus 1.25(0.15–2.8)years; p=0.008] and survival has improved (88.2 versus 60.0 %; p=0.039).

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