Extracorporeal membrane oxygenation for immunocompromised children with acute respiratory distress syndrome: a French referral center cohort

Abstract

Background: Immunocompromised children are likely to develop a refractory acute respiratory distress syndrome (ARDS). The usefulness of providing extracorporeal life support (ECLS) to these patients is a subject of debate. The aim of our study was to report the outcomes and to compare factors associated with mortality between immunocompromised and non-immunocompromised children supported with veno-venous ECMO. Methods:We performed a retrospective monocentric study in the French pediatric ECMO center of Armand Trousseau Hospital, including all pediatric patients aged from 1 month to 18 years requiring ECLS for ARDS.Results: Between 2007 and 2018, one hundred and eleven (111) patients underwent ECMO for respiratory failure; among them twenty-five (25) were immunocompromised. Survival rate at 6 months after intensive care discharge was significantly lower for immunocompromised patients compared to non-immunocompromised ones (41.7% vs. 62.8%; p = 0.04). ARDS severity was similar between the 2 groups. Fungal pneumonias were reported only in immunocompromised patients (12.5% versus 0% in the control group; p = 0.001). Bleeding complications were significantly more frequent in the immunocompromised group and blood product transfusions were also more frequently required in this group. Conclusion:Six months after intensive care discharge, survival rate of immunocompromised children supported with ECMO for pediatric ARDS is lower than for nonimmunocompromised patients. But, the expectation for a favorable outcome is real and it is worth it if their condition is likely to be compatible with a good long-term quality of life.

Outcomes of Children Surviving Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

“…Recent studies demonstrated impairments in HRQL (20, 23–25), functional status (23–30), neurocognitive status (31, 32), emotional health (24), and school participation (18, 33) in the months and years after hospitalization with PARDS, as well as high rates of ongoing care needs after hospital discharge (28, 29, 34), postdischarge health resource use (14, 17, 19), late mortality (14, 18, 23, 31, 35, 36), and work absences for parents (33) ( Table 2 ) (Supplemental Table 9, http://links.lww.com/PCC/C297).…”

“…Postdischarge mortality varied by population and time point evaluated; among PARDS patients requiring ECMO who survived to hospital discharge, postdischarge mortality was 3.0% at 6 months (36) and 5.2% at 1 year (35), whereas among general PICU patients with PARDS, postdischarge mortality was 4.6–5.5% at 1 year (14, 28) and 8.0% at 3 years (28). Among 15 immunocompromised patients with PARDS, 3-year postdischarge mortality was 40% (31) ( Fig.…”

“…Literature characterizing outcomes of survivors of PARDS has grown substantially since PALICC 2015 (4). We now have information about recovery after PICU admission for PARDS in single-center, multicenter, and population-based studies (14, 17–20, 23–36, 39). Unfortunately, it is increasingly clear that morbidity after hospital discharge from PARDS is common and affects all domains of function, HRQL, and patients’ families.…”