Preliminary observation of extracorporeal membrane oxygenation as rescue therapy for refractory hypoxemic respiratory failure in children / 中华急诊医学杂志

ABSTRACT

Objective:To investigate the efficacy of extracorporeal membrane oxygenation (ECMO) in rescuing refractory severe hypoxic respiratory failure in children.Methods:Patients with refractory hypoxic respiratory failure who treated with ECMO from July 2016 to June 2019 in the Department of Intensive Medicine (PICU) of Shanghai Children's Hospital Affiliated to Shanghai Jiaotong University were enrolled in this study. Their oxygen index, initial ECMO timing, organ function, in-hospital survival rate, and ECMO-related complications were collected and analyzed.Results:Totally 30 patients with severe refractory hypoxemia who received ECMO therapy were included. The mean age of patients was 19 ( IQR 9.75, 52) months. Twenty-one patients (70%) treated with veno-arterial (VA-ECMO), 7 patients (23.3%) received veno-venous ECMO (VV-ECMO), and mixed model [one patient (3.3%) VV to VA-ECMO, and one patient (3.3%) VA to VV-ECMO]. The mean duration of ECMO was 161.5 ( IQR 91, 284) h. The total in-hospital survival rate was 66.7%, of which the VA-ECMO survival rate 59.1% (13/21) and the VV-ECMO survival rate 85.7% (6/7) without significant difference (χ 2=1.365, P=0.243). The mean oxygenation index (OI) at initial ECMO intervention was 43 ( IQR 35.3, 60.8) in the non-survival group, which was significantly higher than that in the survival group [26.5 ( IQR 20, 45.3), z=-2.267, P =0.023]. The course of confirmed respiratory failure at ECMO intervention was 129 ( IQR 90.25, 197) h in the non-survival group, which was significantly longer than that in the survival group [54.5 ( IQR 16.25, 121.75) h, z=-2.2464, P =0.014]. Conclusions:Compared with VA-ECMO, the survival rate has a better tendency in VV-ECMO treated patients with refractory severe hypoxic respiratory failure. And patients with OI >43 or severe hypoxic respiratory failure diagnosed for more than 5 days with ECMO support may have worsen prognosis.