AAP Paper
Extracorporeal membrane oxygenation as a lifesaving modality in the treatment of pediatric patients with burns and respiratory failure

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Abstract

Purpose

Several case series have described successful utilization of extracorporeal membrane oxygenation (ECMO) for the treatment of pediatric burn patients with respiratory failure. This study examines the Extracorporeal Life Support Organization registry experience in the treatment of these patients.

Methods

The Extracorporeal Life Support Organization registry was queried from 1999 to 2008 for all patients not older than 18 years who suffered a burn-related injury.

Results

Thirty-six patients met inclusion criteria. The mean age was 4.45 years, with an average weight of 20.9 kg. Survivors vs nonsurvivors had a shorter average time to ECMO (97 vs 126 hours, P = .890) and shorter average ECMO run times (193 vs 210 hours, P = .745). Seventeen patients underwent venovenous ECMO and 19 patients underwent venoarterial ECMO, with survival of 59% (n = 10) and 47% (n = 9), respectively (P = .493; odds ratio, 1.587; 95% confidence interval, 0.424-5.945). Overall survival was 53% (n = 19). Complications occurred in 28 patients (33 mechanical, 101 medical). The venoarterial group had 21 mechanical (n = 8) and 61 medical complications (n = 17), compared with the venovenous group with 12 mechanical (n = 8) and 40 medical complications (n = 11).

Conclusions

Extracorporeal membrane oxygenation can be a lifesaving modality for pediatric burn patients with respiratory failure. Survival is comparable to the reported survival of non–burn-related pulmonary failure pediatric patients requiring ECMO.

Section snippets

Methods

The ELSO registry began in 1989 and contains ECMO cases from more than 170 centers around the world. Currently, there are more than 35,000 cases entered in the registry. The data are deidentified and include patient demographics, diagnostic and laboratory information, as well as clinical course, outcome, and complications. The ELSO registry was queried for patients 18 years and younger from 1999 to 2008 with International Classification of Diseases, Ninth Revision (ICD-9) codes that referred to

Results

The ELSO registry identified 36 patients who suffered cutaneous burns and inhalation injuries that were treated with ECMO during the 10-year study period (Table 1), with 19 surviving to discharge. The mean age was 4.45 years (range, 0.18-15.8 years), with an average weight of 20.9 kg (range, 5-90 kg). There were 22 male and 14 female patients, with a male to female ratio of 1.6:1. The average duration of ventilator support before initiating ECMO was 111 hours (range, 5-517 hours). Survivors

Discussion

The cause of respiratory failure in pediatric patients is heterogeneous and is characterized by alveolar and interstitial disease [18]. The large age discrepancy in the pediatric population implies a spectrum of lung development and maturation that may affect both disease process and the ability of the lungs to recover from a particular insult [18]. This is especially true for pediatric burn patients who may develop ARDS as a result of systemic inflammation caused by their cutaneous burns or

Conclusion

Extracorporeal membrane oxygenation can be a lifesaving modality for pediatric burn patients with pulmonary failure who are nonresponsive to maximal medical management. Survival for this population is 53%, which is at least on par if not slightly better than the reported 47% survival for non–burn-related respiratory failure in pediatric patients requiring ECMO [18], but less than the reported survival in case series for this subset of patients. Pediatric burn patients represent a diverse

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