EXTRACORPOREAL MEMBRANE-OXYGENATION FOR NONNEONATAL PULMONARY AND MULTIPLE-ORGAN FAILURE

Purpose: Extracorporeal membrane oxygenation (ECMO) is an accepted the rapy for neonatal pulmonary failure, but its use in older children has been controversial. Methods: Over 13 years, 55 children (ages, 3 mont hs to 16 years) were treated with venoarterial or venovenous ECMO. The diagnoses were viral, bacterial, or fungal pneumonia (24 patients); h ydrocarbon or gastric aspiration (n = 10); adult respiratory distress syndrome (ARDS), sepsis, near drowning (n = 15); pulmonary contusion ( n = 2); airway obstruction (n = 3); pulmonary artery foreign body (n = 1). Pre-ECMO blood gas ranges (and means) were PO2, 21 to 100 (n = 44 ); PCO2, 23 to 125 (n = 72); pH, 6.81 to 7.55 (n = 7.11). Results: All patients received inotropes, and 38 required dialysis or hemofiltrati on. ECMO was used for 20 to 613 hours (mean, 196 hours). Patient compl ications included cannulation site hemorrhage(n = 40), renal failure ( n = 10), seizures (n = 8), stroke (n = 3), and cerebral hemorrhage (n = 2). Twenty-five patients (45%) survived ECMO, with 21 long-term surv ivors (10 pneumonia, five aspiration, five ARDS, one pulmonary contusi on), five of whom have mild to moderate neurological deficit. Patients with combinations of pulmonary cardiac, a nd renal failure, or sepsis did not survive. Conclusions: ECMO is an invasive technique that can be life saving in the child with isolated respiratory failure, but its usefulness in children with multiorgan failure is less certain. Copyr ight (C) 1998 by W.B. Saunders Company.