Extracorporeal Membrane Oxygenation for Pediatric Burn Patients: Is Management Improving Over Time?

Abstract

Over the last few decades, extracorporeal membrane oxygenation (ECMO) has become a lifesaving modality for patients with severe respiratory failure following burn injury. With the advancement in critical care and ECMO management, this study aims to analyze the outcomes of ECMO in pediatric burn patients. The Extracorporeal Life Support Organization database was queried from 1999 to 2018 for patients 18 years old and under with a burn injury. The data were divided into two decades, the first (1999–2008) and the second (2009–2018), for analysis of background characteristics and clinical outcomes. Ninety-five patients met inclusion criteria. The overall use of ECMO increased in the second decade (60 cases) when compared to the first decade (35 cases), and use of venovenous ECMO increased in the second decade from 16 cases to 38 cases. Although more patients survived because of the increased application of venovenous ECMO, the survival rate was unchanged between decades (53.4% vs. 54.3%; P = 0.937). Patients with pre-ECMO cardiac arrest had a significant improvement in mortality during the second decade (54.5% vs. 0%; P = 0.043). Metabolic (P = 0.022) and renal (P = 0.043) complications were most common in nonsurvivors during the first decade whereas cardiovascular (P = 0.031) and neurologic (P = 0.003) complication were higher in the second decade (P = 0.031, 0.003). Use of ECMO after burn injury has become more common; however, overall mortality remains unchanged. The data suggests pre-ECMO cardiac arrest is no longer a contraindication to start ECMO.

Extracorporeal life support in pediatric burn care: A systematic review

“…The most recent data comes from three different ELSO Registry reviews, published by the groups of Thompson 19 in 2020, Suzuki 20 in 2022 and Patterson 21 in 2022. Thompson et al 19 identified 113 patients between 1990 and 2016.…”

“…Of the patients with documented TBSA <60%, survival was 70%. Another ELSO Registry review from 1999 to 2018 for patients of 18 years and under was conducted by Suzuki et al 20 The data were divided into two decades, the first (1999–2008) and the second (2009–2018). The authors observed that the use of ECMO increased over time, with V-V ECMO as the most common configuration.…”

“…At ECMO initiation, the average APACHE score, SOFA score, and P/F ratio were 21, 9, and 59, respectively, and seven out of eight patients survived. 18 The most recent data comes from three different ELSO Registry reviews, published by the groups of Thompson 19 in 2020, Suzuki 20 in 2022 and Patterson 21 in 2022. Thompson et al 19 identified 113 patients between 1990 and 2016.…”