Does Extracorporeal Membrane Oxygenation Improve Survival in Pediatric Acute Respiratory Failure?

Barbaro, Ryan P.; Xu, Yuejia; Borasino, Santiago; Truemper, Edward J.; Watson, R. Scott; Thiagarajan, Ravi R.; Wypij, David; Curley, Martha A. Q.

doi:10.1164/rccm.201709-1893oc

Cited by 46 publications

(50 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This data has particular value in conversations with patients and caregivers, and can be used to convey prognostication and set expectations for survival in both the short-and long-term, given the existing data. Overall mortality rates were higher among patients with respiratory failure, which is contrary to what has been seen previously [8][9][10]. Although the reason for this remains unclear, it may reflect the selective use of ECMO at the included centers, as compared to other centers in the ELSO database.…”

Section: Discussioncontrasting

confidence: 76%

“…Across the world, ECMO utilization was historically more common among neonates than older children; however, this trend has changed over the last decade with an increase in pediatric cardiac and pediatric respiratory utilization [9]. For patients with respiratory failure, in-hospital mortality among those receiving ECMO (largely venovenous [VV-ECMO]) was approximately 25% and did not differ from propensity-matched controls [10]. However, in the pediatric population, venoarterial ECMO (VA-ECMO) is more common.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Fernando¹,

Qureshi²,

Tanuseputro³

et al. 2020

Crit Care

View full text Add to dashboard Cite

Background: Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. Methods: Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO, identified through the use of an ECMO procedural code. Outcomes were identified through linkage to provincial health databases. Primary outcome was survival, measured to hospital discharge, as well as at 1 year, 2 years, and 5 years following ECMO initiation. We evaluated total patient costs in the first year following ECMO. Results: We analyzed 342 pediatric patients. Mean age at ECMO initiation was 2.9 years (standard deviation [SD] = 5.0). Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1-13 days). Overall survival to hospital discharge was 56.4%.

show abstract

Section: Discussioncontrasting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Fernando¹,

Qureshi²,

Tanuseputro³

et al. 2020

Crit Care

View full text Add to dashboard Cite

show abstract

“…To date, no RCT examining the effect of ECMO on outcome in pediatric sepsis has been published. In the absence of such data, using propensity score matching, Barbaro et al [481] reported that children with severe PARDS enrolled in the RESTORE trial had similar mortality rates when supported with ECMO (15/61, 25%) as compared with those who were not (18/61, 30%) [482] (Supplemental Table 33, Supplemental Digital Content 1, http://links .lww.com/PCC/B139). Research is underway to determine optimal pre-ECMO candidacy [483] as measures of renal, hepatic, neurologic, and hematologic dysfunction, and particularly the presence of bloodstream infections, seem to discriminate mortality risk better than traditional pediatric severity of illness scores such as PRISM, Pediatric Index of Mortality, and Pediatric Logistic Organ S47 Dysfunction.…”

Section: We Suggest Using Venovenous Ecmo In Children With Sepsis-indmentioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

View full text Add to dashboard Cite

Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

show abstract

“…In adults with very severe acute respiratory distress syndrome (ARDS), the ECMO for Severe ARDS (EOLIA) trial was stopped early for a predicted lack of a significant difference in the primary outcome of mortality at 60 days between the ECMO and the continued conventional treatment arms ( 17 ). A similar trial has not been conducted in children, however recent results from a secondary analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial suggest that a trial of ECMO vs. continued conventional management for severe pediatric ARDS may be justified ( 18 ). The authors' conclusion was based on lack of differences in patient outcomes comparing RESTORE study participants managed with ECMO vs. matched controls managed with conventional mechanical ventilation, along with the finding of wide variability in clinical practice with regards to mechanical ventilation strategies and determination of ECMO candidacy and timing for ECMO cannulation that confirmed previously published survey data ( 18 , 19 ).…”

Section: Clinical Research Studies In Critically Ill Children On Ecmomentioning

confidence: 99%

Pediatric ECMO Research: The Case for Collaboration

2018

View full text Add to dashboard Cite

The use of extracorporeal membrane oxygenation (ECMO) in the pediatric age has increased considerably in the last decade, as has the complexity of cases and the variety of indications outside of the neonatal age. However, no randomized controlled trials have been attempted to date to test ECMO as an intervention in non-neonatal pediatric patients with critical illness. In this review, we provide a brief overview of the history of clinical research in pediatric ECMO and discuss methodological challenges including heterogeneity of ages and diagnoses in the pediatric ECMO population, rapid advances in technology and clinical practice related to ECMO, feasibility of enrolling critically ill children on ECMO in clinical research studies, and variability in ECMO management across institutions and countries. Lastly, we discuss opportunities and existing infrastructure for future multicenter, multi-network research collaborations for pediatric ECMO studies.

show abstract

Does Extracorporeal Membrane Oxygenation Improve Survival in Pediatric Acute Respiratory Failure?

Abstract: In children with severe ARDS, our results do not demonstrate that ECMO-supported children have superior outcomes compared with non-ECMO-supported children. Definitive answers will require a rigorous multisite randomized controlled trial.

Cited by 46 publications

References 56 publications

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Pediatric ECMO Research: The Case for Collaboration

Contact Info

Product

Resources

About