Pediatric Original

Intensive Care Medicine

, Volume 38, Issue 6, pp 1001-1007

Outcomes in children with refractory pneumonia supported with extracorporeal membrane oxygenation

  • Nathan SmalleyAffiliated withPaediatric Intensive Care Unit, Royal Children’s Hospital Email author 
  • , Graeme MacLarenAffiliated withPaediatric Intensive Care Unit, Royal Children’s HospitalCardiothoracic Intensive Care Unit, National University Hospital
  • , Derek BestAffiliated withPaediatric Intensive Care Unit, Royal Children’s Hospital
  • , Eldho PaulAffiliated withSchool of Public Health and Preventive Medicine, Monash University
  • , Warwick ButtAffiliated withPaediatric Intensive Care Unit, Royal Children’s HospitalDepartment of Paediatrics, University of MelbourneCritical Care and Neuroscience Theme, Murdoch Children’s Research Institute

Abstract

Purpose

To review the use of extracorporeal membrane oxygenation (ECMO) in severe paediatric pneumonia and evaluate factors that may affect efficacy of this treatment.

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. We 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).

Conclusions

Survival in children with pneumonia requiring ECMO has improved over time and is now 90 % in the modern era. Risk factors for death include performing a circuit change [odds ratio (OR) 5.0; 95 % confidence interval (CI) 1.02–24.41; p = 0.047] and use of continuous renal replacement therapy (OR 4.2; 95 % CI 1.13–15.59; p = 0.032).

Keywords

Pneumonia Paediatric Extracorporeal membrane oxygenation Venovenous Venoarterial Survival