Belevskaia Liudmila, von Borell Florian, Baumann Ulrich, Beier Rita, Köditz Harald
Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
Department of Paediatric Pulmonology and Neonatalogy, Hannover Medical School, Hannover, Germany.
Front Oncol. 2025 Jul 8;15:1613864. doi: 10.3389/fonc.2025.1613864. eCollection 2025.
Extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in pediatric patients with severe respiratory failure, extending its use to high-risk patients, including those who are immunocompromised. Despite its growing application, reports on outcomes and prognostic factors in this specific population are scarce, highlighting a gap in our understanding.
This retrospective cohort study analyzed the outcomes of 19 immunocompromised pediatric patients who received ECMO for respiratory failure at our institution between 2006 and 2023. Patients were classified as immunocompromised due to conditions such as cancer, hematopoietic cell transplantation (HCT), primary immunodeficiency or receiving immunosuppression for a chronic (auto-) inflammatory disease. Data on patient demographics, baseline laboratory and ventilation parameters were collected and compared between survivors and non-survivors.
The median age of patients was 12.1 years, and the majority suffered from infectious pneumonia leading to respiratory failure. The median duration of ventilation before ECMO was 5 days, and ECMO support lasted a median of 19 days. The hospital mortality rate in this cohort was 74% (14/19). All patients who had undergone HCT or a primary immunodeficiency did not survive. Non-survivors exhibited significantly higher median C-reactive protein levels and more bleeding complications. Other laboratory and respiratory parameters, as well as vasopressor requirements, pSOFA, and P-PREP scores, were similar across survivors and non-survivors.
The treatment of immunocompromised pediatric patients with ECMO for respiratory failure presents notable challenges. This study highlights the complexity of predicting outcomes in this group, as traditional laboratory and respiratory parameters were not distinctly different between survivors and non-survivors. These findings indicate a need for continued research and nuanced clinical approaches to improve care and outcomes in this vulnerable population.
体外膜肺氧合（ECMO）在患有严重呼吸衰竭的儿科患者中的应用越来越多，其使用范围已扩展到高危患者，包括免疫功能低下的患者。尽管其应用日益广泛，但关于这一特定人群的治疗结果和预后因素的报告却很少，这凸显了我们在认识上的差距。
这项回顾性队列研究分析了2006年至2023年期间在我们机构接受ECMO治疗呼吸衰竭的19例免疫功能低下的儿科患者的治疗结果。患者因癌症、造血细胞移植（HCT）、原发性免疫缺陷或因慢性（自身）炎症性疾病接受免疫抑制等情况而被归类为免疫功能低下。收集了患者的人口统计学数据、基线实验室和通气参数，并在幸存者和非幸存者之间进行了比较。
患者的中位年龄为12.1岁，大多数患者患有导致呼吸衰竭的感染性肺炎。ECMO前的中位通气时间为5天，ECMO支持的中位持续时间为19天。该队列中的医院死亡率为74%（14/19）。所有接受过HCT或患有原发性免疫缺陷的患者均未存活。非幸存者的中位C反应蛋白水平显著更高，出血并发症更多。其他实验室和呼吸参数，以及血管升压药需求、pSOFA和P-PREP评分，在幸存者和非幸存者之间相似。
用ECMO治疗免疫功能低下的儿科呼吸衰竭患者面临着显著挑战。本研究强调了预测该组患者预后的复杂性，因为传统的实验室和呼吸参数在幸存者和非幸存者之间没有明显差异。这些发现表明需要持续进行研究并采取细致入微的临床方法，以改善这一脆弱人群的护理和治疗结果。
