THE USE OF EXTRACORPOREAL LIFE-SUPPORT IN PEDIATRIC BURN PATIENTS WITH RESPIRATORY-FAILURE

Respiratory failure is the most common cause of death after thermal in jury and may be caused by inhalation injury, acute respiratory distres s syndrome (ARDS) or pneumonia. ARDS is usually associated with sepsis ; however, it may also occur during burn shock, especially in patients that have a delayed or inadequate fluid resuscitation.(1) During the past 24 months, five pediatric burn patients underwent extracorporeal life support (ECLS) for respiratory failure unresponsive to optimal me dical management. The mean age of the patients was 26 months (range, 8 .5 to 48 months), with a mean burn size of 46% TBSA (>95% third degree ). The etiology of the respiratory failure included severe bronchospas m in a 22-month-old former premature infant with bronchopulmonary dysp lasia; three patients with ARDS and one patient with a severe inhalati on injury. All five patients required greater than 56 cm H2O peak pres sures and 100% FlO(2) at the time of beginning ECLS. The oxygenation i ndex (OI) ranged from 45 to 180. Three (60%) of the patients survived. In the three patients who ultimately survived, significant improvemen ts in pulmonary and hemodynamic parameters occurred within 96 hours of ECLS. The two patients who died showed no improvement and were remove d from ECLS at 10 and 11 days; both expired within hours. The patients who expired developed significant hemodynamic instability, coagulopat hy, and hemorrhage from their burn wounds. The extent and degree of bu rn injury did not seem to alter the outcome. Indications for consideri ng ECLS in the pediatric burn patient are unmanageable, life threateni ng pulmonary insufficiency in patients that undergo a relative short c ourse of pre-ECLS ventilator support. The principles consist of surviv ors showing a rapid improvement; and if possible, initial excision and allografting before support should be beneficial. ECLS appears to be a viable therapy for burned children with acute respiratory failure wh en maximal conventional pulmonary support is failing. Copyright (C) 19 95 by W.B. Saunders Company