Clinical Experience of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome Associated with Pneumonia in Children

Background/purpose: To describe a single center's experience with pediatric patients receiving extracorporeal membrane oxygenation (ECMO) for respiratory failure due to acute respiratory distress syndrome (ARDS) associated with pneumonia and to investigate the factors associated with mortality.

Methods: Retrospective chart review of all pediatric patients receiving ECMO for severe ARDS associated with pneumonia and sepsis from December 2001 to October 2009 in the pediatric intensive care unit (ICU) and cardiovascular surgery ICU at a tertiary medical center, to investigate the factors associated with mortality.

Results: Twelve patients had pneumonia and sepsis with progression to ARDS. The duration of intubation prior to ECMO was 19.92±10.40 hours. The duration of ECMO support was 241.08±194.93 hours. The range of PaO(2)/FiO(2) was 42-69.9, alveolar-arterial oxygen gradient (AaDO(2)) 602-645, and oxygenation index (OI) 27.4-68. The pre-ECMO intubation duration in the initial venoarterial ECMO group was significantly different from the venovenous ECMO group (9.4±10.93 vs. 151.25±152.16 hours). The overall survival to lung recovery rate was 66.7% (8/12) and survival to discharge rate 58.3%. The survival rate to lung recovery improved from 20% (between 2001 and 2003) to 100% (after 2004). Between the survival and nonsurvival groups, only ICU days and total intubated days were significantly longer in survivors. Although without statistical significance, the nonsurvivors tended to have lower white blood cell counts, higher C-reactive protein (CRP), and longer pre-ECMO intubation time. Seven of the 12 patients had bacterial pneumonia, higher CRP and creatinine values, and a lower hospital survival rate compared to the nonbacterial group (42.8% vs. 80%).

Conclusion: Application of ECMO in pediatric patients with severe ARDS seems effective in improving survival, even under the conditions of pneumonia with septic shock.