EXTRACORPOREAL MEMBRANE-OXYGENATION FOR PEDIATRIC RESPIRATORY-FAILURE- 5-YEAR EXPERIENCE AT THE UNIVERSITY-OF-PITTSBURGH

Objectives: To describe the etiology, respiratory severity of illness, and outcome in patients with pediatric respiratory failure who were t reated with extracorporeal membrane oxygenation (ECMO). To identify pr edictors of death, and to compare our morbidity and mortality rates wi th those rates of a previously reported series of patients with pediat ric respiratory failure managed conventionally. Design: Survey, case s eries. Setting: Intensive care unit in a tertiary care pediatric hospi tal. Patients: Twenty-eight pediatric patients (3 wks to 20 yrs of age ) who underwent ECMO for pediatric respiratory failure between 1985 an d 1991. Measurements and Main Results: Thirteen (46%) of the 28 patien ts survived. The most common diagnoses were adult respiratory distress syndrome and nonspecific pneumonitis. Multiple organ system failure o ccurred in only four (14%) patients; most patients died of respiratory failure. The occurrence of persistent airleak during ECMO was signifi cantly greater in nonsurvivors than in survivors. Furthermore, nonsurv ivors had significantly less response to lung reexpansion maneuvers co mpared with survivors, as measured by a calculated compliance index (e ffective tidal volume/mean airway pressure x 100). The mortality rate was comparable with those rates of other published studies of conventi onally managed and ECMO-treated patients with pediatric respiratory fa ilure. Moreover, our patients appeared to exhibit more severe respirat ory failure at the start of ECMO than those patients in other studies. Conclusions: ECMO appears to be a rational therapy for patients with pediatric respiratory failure who are likely to die with continued con ventional management. Recovery of lung function by the end of the firs t week of ECMO may be a favorable prognostic indicator. Persistent air leak may be a nonfavorable prognostic indicator.