Extracorporeal life support for severe pediatric respiratory failure: an updated experience 1991-1993.

OBJECTIVE

The purpose of this study was to examine our recent experience with children who had acute respiratory failure managed with extracorporeal life support (ECLS) from 1991 to 1993, to determine whether a change in survival rate had occurred in comparison with our previous experience.

DESIGN

Historic and prospective cohort study.

SETTING

A tertiary pediatric referral center.

PATIENTS

All non-neonatal pediatric patients treated with ECLS for severe, life-threatening respiratory failure were examined. Overall, 25 patients have been managed with this life-support technique in the past 28 months. Eighty-four percent (21/25) were transferred to our medical center because of failure of conventional mechanical ventilation therapy. Descriptive data of the recent cohort were as follows (mean +/- SD): age 60 +/- 75 months, weight 23.6 +/- 24.8 kg, and male gender 44%. Duration of intubation before ECLS was 5.8 +/- 2.7 days. Arterial blood gas values and ventilator settings immediately before ECLS were as follows: fraction of inspired oxygen, 0.98 +/- 0.08; mean airway pressure, 21.6 +/- 6.2 cm H2O; peak inspiratory pressure, 45.5 +/- 9.6 cm H2O; positive end-expiratory pressure, 11.0 +/- 4.3 cm H2O; partial pressure of oxygen (arterial), 56 +/- 20 mm Hg (7.4 +/- 2.7 kilopascals); partial pressure of carbon dioxide (arterial), 46 +/- 17 mm Hg (6.1 +/- 2.3 kPa); and estimated alveolar-arterial oxygen tension difference, 572 +/- 81 mm Hg (76.3 +/- 10.8 kPa). Mean duration of ECLS was 373 +/- 259 hours. Of 25 recently treated patients, 22 (88%) survived their life-threatening respiratory illness to be discharged home; this represented a statistically improved survival rate in comparison with the 58% survival rate previously reported by us for similar patients (p < 0.05). Comparisons of arterial blood gas and mechanical ventilation-related variables measured 24 hours before and again immediately before bypass were similar in the two cohorts with the exception of higher mean partial pressure of carbon dioxide (arterial) 24 hours before bypass in the recent treatment group. For our entire experience, younger age groups had greater survival rates; 100% of infants less than 1 year of age survived.

CONCLUSIONS

Treatment with ECLS is an evolving pulmonary rescue therapy with an 88% survival rate in our recent experience. The survival rate has improved to levels that may not greatly improve in the near future, especially for patients less than 1 year of age. Better patient selection or improved management strategies or both may be responsible for the improved patient outcome.