EXTRACORPOREAL LIFE-SUPPORT FOR PEDIATRIC RESPIRATORY-FAILURE - PREDICTORS OF SURVIVAL FROM 220 PATIENTS

Objective. The purpose of this report was to examine the Extracorporea l Life Support Organization registry database for predictors of outcom e for severe pediatric respiratory failure managed with extracorporeal life support. Design: Retrospective cohort study. Setting: Extracorpo real Life Support Organization data registry. Patients: All nonneonata l pediatric patients who were treated in the United States with extrac orporeal life support for severe pediatric respiratory failure reporte d to the Extracorporeal Life Support Organization registry as of Augus t 1991. Patients with congenital heart disease and congenital gastroin testinal malformations were excluded from study. Interventions: Venoar terial or venovenous extracorporeal life support for severe life-threa tening pulmonary failure. Measurements and Main Results: As of August 1991, 220 pediatric patients meeting study entry criteria were reporte d to the Registry having received extracorporeal life support for seve re pulmonary failure, since 1982. Forty-six percent (102 of 220 patien ts) were successfully managed with this technology and survived to hos pital discharge. The mean patient age was 36.8 +/-51.6 months. Fifty-o ne percent of the patients were male. The mean duration of mechanical ventilation before extracorporeal life support was 6.3 +/- 5.9 days. M ean blood gas and ventilatory measurements obtained before extracorpor eal life support were as follows: Paco2 52 +/- 23 torr (6.9 +/- 3.0 kP a); Pao2 59 +/- 32 torr (7.8 +/- 4.3 kPa); estimated alveolar-arterial oxygen gradient 561 +/- 63.4 torr (74.8 +/- 8.5 kPa); peak airway pre ssure 49.5 +/- 13.1 cm H2O; mean airway pressure 24.3 +/- 8.2 cm H2O; positive end-expiratory pressure 11.8 +/- 6.3 cm H2O; ventilator rate 58 +/- 64.4 breaths/min; and FIO2 0.98 +/- 0.07. The mean duration of extracorporeal life support for all patients was 247 +/- 164 hrs. For the 102 survivors, the mean time for decannulation from extracorporeal life support to extubation from mechanical ventilation was 6.5 +/- 7. 6 days. Step-wise multivariate logistic regression modeling found the following variables to be associated with patient survival: a) patient age, b) days of mechanical ventilation before extracorporeal fife sup port, c) peak inspiratory pressure, d) alveolar-arterial oxygen gradie nt, and e) extracorporeal life support administered since December 31, 1988 (all p < .05). Conclusions: Extracorporeal life support may repr esent an effective rescue therapy for some selected pediatric patients with severe respiratory failure for whom conventional mechanical vent ilation support has failed to improve. Predictors of survival for this life-support therapy exist that may be helpful for individual patient prognostication and future prospective study.