EXTRACORPOREAL MEMBRANE-OXYGENATION IN CH ILDREN WITH ACQUIRED RESPIRATORY-DISTRESS SYNDROME

From 1987 to 1993 44 children (aged 0.3-13 years) suffering from sever e ARDS (paO2/FiO2<100) were treated in our hospital. 38 of these patie nts were transferred from other hospitals for eventual treatment with extracorporeal lung support. In 27 children respiratory insufficiency could be overcome by optimization of respiratory (heightened PEEP, inv ersed ratio ventilation) and medical therapy. In 17 patients, however, continuation of conventional management failed to alleviate the ARDS, therefore extracorporeal membrane oxygenation (ECMO) became an altern ative. Four patients with brain hemorrhage and poor neurological statu s were excluded from ECMO. The remaining 13 patients had extracorporea l lung support for between 86-408 hours. 8/13 children recovered durin g extracorporeal bypass without severe chronic sequelae; 5 patients di ed while on or shortly after extracorporeal lung support. In our opini on children with severe ARDS have a much better prognosis than equally effected adults (overall mortality rate in our population: 21%). Wher e conventional treatment fails extracorporeal lung support is a promis ing form of therapy. Persistent hypoxemia and excessive ventilation pa rameters (high OI) before ECMO reduce the effectiveness of this method ; immunocompromised children do not benefit from extracorporeal lung s upport.