EXTRACORPOREAL LIFE-SUPPORT FOR SEVERE PEDIATRIC RESPIRATORY-FAILURE - AN UPDATED EXPERIENCE 1991-1993

Objective: The purpose of this study was to examine our recent experie nce with children who had acute respiratory failure managed with extra corporeal life support (ECLS) from 1991 to 1993, to determine whether a change in survival rate had occurred in comparison with our previous experience. Design: Historic and prospective cohort study. Setting: A tertiary pediatric referral center. Patients: All nonneonatal pediatr ic patients treated with ECLS for severe, life-threatening respiratory failure were examined. Overall, 25 patients have been managed with th is life-support technique in the past 28 months. Eighty-four percent ( 21/25) were transferred to our medical center because of failure of co nventional mechanical ventilation therapy. Descriptive data of the rec ent cohort were as follows (mean +/- SD): age 60 +/- 75 months, weight 23.6 +/- 24.8 kg, and male gender 44%. Duration of intubation before ECLS was 5.8 +/- 2.7 days. Arterial blood gas values and ventilator se ttings immediately before ECLS were as follows: fraction of inspired o xygen, 0.98 +/- 0.08; mean airway pressure, 21.6 +/- 6.2 cm H2O; peak inspiratory pressure, 45.5 +/- 9.6 cm H2O; positive end-expiratory pre ssure, 11.0 +/- 4.3 cm H2O; partial pressure of oxygen (arterial), 56 +/- 20 mm Hg (7.4 +/- 2.7 kiloposcals); partial pressure of carbon dio xide (arterial), 46 +/- 17 mm Hg (6.1 +/- 2.3 kPa); and estimated alve olar-arterial oxygen tension difference, 572 +/- 81 mm Hg(76.3 +/- 10. 8 kPa). Mean duration of ECLS was 373 +/- 259 hours. Of 25 recently tr eated patients, 22 (88%) survived their life-threatening respiratory i llness to be discharged home; this represented a statistically improve d survival rate in comparison with the 58% survival rate previously re ported by us for similar patients (p<0.05). Comparisons of arterial bl ood gas and mechanical ventilation-related variables measured 24 hours before and again immediately before bypass were similar in the two co horts with the exception of higher mean partial pressure of carbon dio xide (arterial) 24 hours before bypass in the recent treatment group. For our entire experience, younger age groups had greater survival rat es; 100% of infants less than 1 year of age survived. Conclusions: Tre atment with ECLS is an evolving pulmonary rescue therapy with an 88% s urvival rate in our recent experience. The survival rate has improved to levels that may not greatly improve in the near future, especially for patients less than 1 year of age. Better patient selection or impr oved management strategies or both may be responsible for the improved patient outcome.