EXTRACORPOREAL MEMBRANE-OXYGENATION FOR REFRACTORY SEPTIC SHOCK IN CHILDREN

Objective. To review demographic data and outcome of children who rece ived extracorporeal membrane oxygenation (ECMO) for refractory septic shock. Method. Review of medical charts of nine children receiving ECM O for culture-proven refractory septic shock treated in a multidiscipl inary pediatric intensive care unit. Results. Median age was 12 years and median weight was 45 kg. Median inotrope requirements (mu g/kg per minute) before ECMO were dopamine, 15; dobutamine, 12.5; epinephrine, 4; and norepinephrine, 3.5. Four children received two inotropes conc urrently, and five received three or more. All nine patients had sever e respiratory failure; eight had evidence of other organ system dysfun ction, with six having five or more organ system dysfunctions. Median PRISM score was 27. Median duration of ECMO was 137 hours. Within 24 h ours of starting ECMO, 7 of 9 children had all inotropes stopped. Four patients died and five survived, all of whom are leading normal lives . Conclusion. In this small group of children with probably fatal sept ic shock, ECMO was successfully supported the circulation and 5 of the 9 children survived. We suggest that septic shock should not be consi dered a contraindication to ECMO.