Extracorporeal membrane oxygenation rescue for critically ill children with cardiopulmonary failure / 中华急诊医学杂志

ABSTRACT

Objective To summarize the therapeutic effects of extracorporeal membrane oxygenation (ECMO) on critically ill children with severe cardiopulmonary failure.Methods The pediatric patients supported with ECMO admitted to pediatric intensive care unit (PICU) from December 2015 to August 2017 were enrolled in this study.The data of demographics of patients,diagnosis,indication for ECMO,the procedure of ECMO support,complications,and survival status were analyzed.Results A total of 17 pediatric patients including 9 male and 8 female with severe cardiopulmonary failure treated with ECMO were studied.The median of age was 24 (2,117) months,and the median of body weight was 12 (5,33) kg.The indications for initiation of ECMO were cardiovascular failure with poor response to conventional therapy and severe acute respiratory distress syndrome (ARDS) without any beneficial effect obtained from mechanical ventilation.The percutaneous cannulation was done under ultrasound guidance by a team of trained intensivists through right cervical vein and internal carotid artery resulting in veno-arterial extracorporeal membrane oxygenation support.The mean duration of ECMO support was 212.5 h with median 188.5 (3-924) h.All patients were treated with mechanical ventilation for prevention from pulmonary atelectasis.Of 17 patients,10 were coupled with continuous renal replacement therapy (CRRT) to keep fluid balance.As a result,11 children (64.7％) were successfully weaned from ECMO defined as survival for 24 h after ECMO,and 10 children (58.8％) were alive to discharge from hospital.One of 2 cardiac arrest cases treated with extracorporeal cardiopulmonary resuscitation (ECPR) was alive.During ECMO support,there were 41 adverse events happened including pressure ulcers (64.7％),thrombocytopenia (52.9％),bleeding (35.3％).Conclusions The survival rate at discharge was 58.8％ in pediatric patients with severe cardiopulmonary failure with poor response to conventional therapy.Our data suggest that ECMO support is an important rescue technique for pediatric critical illness.