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Complication accrual impacts pediatric extracorporeal life support mortality

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Abstract

Introduction

This study tested the hypothesis that complication accrual during pediatric extracorporeal life support (ECLS) increases mortality irrespective of indication for support.

Methods

Prospectively collected Extracorporeal Life Support Organization (ELSO) registry data for all neonatal and pediatric patients cannulated for ECLS at our institution from 1/1/2015 to 12/31/2020 was stratified based on the presence or absence of complications. We excluded renal replacement therapy from complications, as this is frequently and empirically applied within our practice.

Results

Of 114 patients, overall survival to discharge was 66%. 62 patients (54%) had 149 total complications: 29% were mechanical (circuit related), and the rest were patient related. Age (neonatal versus pediatric), sex, race/ethnicity, support type, presence of pre-ECLS arrest, pre-ECLS pH and intubation-to-ECLS duration were not significantly associated with the development of complications. Patients with complications required longer ECLS duration (168 versus 86 median hours, p < 0.001) and were more likely to be decannulated due to death or poor prognosis (25% versus 8%, p = 0.022). One or more ECLS complications was associated with significantly decreased survival by Cox proportional hazard regression (p = 0.003).

Conclusion

Complications on ECLS are associated with longer support duration and predict decreased survival independent of pre-ECLS variables, suggesting a multidisciplinary ECLS team target for improved outcomes.

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Notes

  1. Renal replacement therapy is defined in the ELSO registry database as Peritoneal Dialysis, Continuous Venovenous Hemodiafiltration (CVVHD), Continuous Venovenous Hemofiltration (CVVHF) or Continuous Venovenous Hemodiafiltration (CVVHDF) or Hemodialysis (HD) based on the patient's ultimate mode of therapy. At our institution, we empirically utilize CVVHD.

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Acknowledgements

There was no source of funding for this research.

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Authors and Affiliations

  1. College of Medicine, Medical University of South Carolina, 10 McClennan Banks Drive, SJCH 2190/MSC 918, Charleston, SC, 29425, USA

    Lauren E. Adams

  2. Department of Surgery, Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA

    Rupak Mukherjee

  3. Department of Surgery, Division of Pediatric Surgery, Medical University of South Carolina, Charleston, SC, USA

    Laura E. Hollinger

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  1. Lauren E. Adams
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  2. Rupak Mukherjee
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  3. Laura E. Hollinger
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Contributions

Study conception and design: LEH; data acquisition: LEA and LEH; analysis and data interpretation: LEA, LEH, and RM; drafting of the manuscript: LEA, LEH, and RM; critical revision: LEA, LEH, and RM.

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Correspondence to Lauren E. Adams.

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The authors declare no financial conflicts of interest.

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Adams, L.E., Mukherjee, R. & Hollinger, L.E. Complication accrual impacts pediatric extracorporeal life support mortality. Pediatr Surg Int 38, 985–991 (2022). https://doi.org/10.1007/s00383-022-05140-z

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  • DOI: https://doi.org/10.1007/s00383-022-05140-z

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