PROBABILITY OF SURVIVAL AFTER PROLONGED EXTRACORPOREAL MEMBRANE-OXYGENATION IN PEDIATRIC-PATIENTS WITH ACUTE RESPIRATORY-FAILURE

Objective: Extracorporeal membrane oxygenation (ECMO) has been used wi th increasing frequency for respiratory failure that is unresponsive t o conventional therapy, We examined the relationship between duration of ECMO and outcome to understand whether prolonged ECMO (duration of the procedure for > 14 days) was more commonly associated with futile therapy or eventual recovery. Design: A cohort study of all patients r eported to the Pediatric ECMO Registry for Acute Respiratory Failure o f the Extracorporeal Life Support Organization. Setting: Tertiary hosp itals (n = 83) capable of providing extracorporeal support for pediatr ic patients. Patients: Children (n = 382) between the ages of I wk and 18 yrs of age with severe respiratory failure. Interventions: Extraco rporeal membrane oxygenation. Measurements and Main Results: The death or live hospital discharge of ECMO-treated patients, together with th e post-ECMO mechanical ventilation course, were examined as a function of duration of ECMO and of pre-ECMO respiratory status, The occurrenc e of complications and the causes of death were also noted, The criter ia used to initiate ECMO, as well as the determination of the futility of further ECMO, were determined by local practice at individual cent ers, There were 382 patients treated with ECMO, of whom 184 (48%) surv ived, The proportional survival in the patients treated for the longes t duration was similar to the overall group, The cause of death was gi ven for 168 patients: 32 neurologic deaths; nine deaths due to ECMO co mplications; and 30 deaths due to nonpulmonary organ failure, There we re 97 deaths due to elective ECMO termination; 80 of these deaths occu rred after the determination of the futility of anticipating pulmonary recovery, The latter deaths occurred at widely varying durations of E CMO, with a median of 282 hrs, However, at that same duration, 47 even tual survivors (26% of all survivors) continued to receive ECMO, By di scriminant analysis, the survival rate was independently related (r(2) =. 18; p < .0001) to peak ventilator inspiratory pressure before ECMO and duration of intubation before ECMO, patient age, and the occurren ce of several complications. Conclusions: While the survival rate in p ediatric patients receiving ECMO appears related to the severity of lu ng disease and to the occurrence of ECMO complications, the survival r ate in patients treated with ECMO courses of > 2 wks was similar to th e survival rate of patients treated for shorter periods of time, ECMO was terminated in some patients for pulmonary futility at durations of ECMO associated with survival in substantial numbers of patients in w hom ECMO was continued.