Pediatric ECMO Research: The Case for Collaboration

Abstract

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.

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

“…Extracorporeal membrane oxygenation (ECMO) provides cardiorespiratory support to patients who have failed initial, conventional treatment [1,2]. In pediatric populations, ECMO is used for organ support in cases of respiratory failure, cardiac failure, and as an adjunct to cardiopulmonary resuscitation (E-CPR) during cardiac arrest [3][4][5][6].…”

“…With the use of ECMO evolving [9], there is a growing need to understand its impact on long-term patient outcomes and system cost. The majority of evidence surrounding the efficacy of ECMO in the pediatric population comes from institutional cohort studies, as very few randomized trials have been performed [2]. 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].…”

Veno-Venous Extra-Corporeal Membrane Oxygenation (ECMO) in a Child with Hemoptysis and Fontan Circulation

“…Extracorporeal membrane oxygenation (ECMO) in the neonatal and pediatric population has been developed more than 45 years ago [1]. This extracorporeal life support (ECLS) technique has been used in life threatening situations of respiratory and/or cardiac failure as a rescue therapy.…”

“…This extracorporeal life support (ECLS) technique has been used in life threatening situations of respiratory and/or cardiac failure as a rescue therapy. Several indications for ECMO implantation have been reported and depend on patient age [1]. These included asthma, bronchiolitis, pneumonia, non-pulmonary infection, drowning, inhalation, foreign body, trauma, congenital heart disease, congenital diaphragmatic hernia, meconium aspiration syndrome, persistent pulmonary hypertension of the newborn, respiratory distress syndrome and sepsis [1].…”

Pediatric oncology—The final frontier for extracorporeal membrane oxygenation in children?

“…In the larger study, Steppan and colleagues leverage multicenter data from the granular Pediatric ECMO Outcomes Registry (PEDECOR, a collaboration within the Pediatric Acute Lung Injury and Sepsis Investigators, PALISI Network), 11 to describe a cohort of children with oncological diagnoses and/or HSCT treatment who were managed on ECMO 10 . The premise of this analysis is the widening indications for ECMO cannulation without empiric evidence of benefits and harms in this population 1 .…”