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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1758480
Original Article

Outcomes of Pediatric Patients with Sepsis Managed on Extracorporeal Membrane Oxygenation: An Analysis of the Extracorporeal Life Support Organization Registry

Adrian Holloway 
1   Division of Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Jason Custer
1   Division of Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Ripal Patel
1   Division of Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Peta Alexander
2   Division of Pediatric Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States
,
Peter Rycus
3   Extracorporeal Life Support Organization, Executive Director, Ann Arbor, Michigan, United States
,
Cortney Foster
1   Division of Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Dayanand Bagdure
1   Division of Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Angelina June
4   Neonatal and Perinatal Medicine, University of Virginia Children's Hospital, Charlottesville, VA, United States
,
Vladimir Michtcherkin
5   School of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
William Blackwelder 
5   School of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Carissa Baker-Smith
6   Nemours Cardiac Center at Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States
,
Adnan Bhutta
7   Pediatric Critical Care Medicine, Indiana University School of Medicine/Riley Childrens Health, Imdianapolis, Indiana, United States
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Abstract

Extracorporeal membrane oxygenation (ECMO) support is increasingly used for refractory septic shock. There is a lack of data on the outcomes of children requiring ECMO support for refractory septic shock. Our study objective was to describe the variables associated with survival, risk factors for mortality, and outcomes of children requiring ECMO support for refractory shock. This was retrospective registry study of 340 international centers contributing data to the ELSO Registry, analyzing children <18 years who received ECMO with septic shock, severe sepsis, sepsis, systemic inflammatory response syndrome, toxic shock syndrome, shock associated with infection, and septicemia from any organism from 1990 to 2015. Outcomes were analyzed by categorizing the data into survivors and nonsurvivors. Logistic regression models were used to describe the association of dependent variable and multiple independent variables. A total of 1,928 patients were identified who met the inclusion criteria. In total, 744 (38.5%) of the cohort survived. Survivors in this cohort tend to have a longer duration of ECMO (230 vs. 201 hours, p = 0.005) and shorter time from intubation to ECMO cannulation (87 vs. 116 hours, p = 0.0033) when compared to nonsurvivors. Survivors were also noted to have higher pH, higher serum bicarbonate, higher saturations, and higher systolic, diastolic, and mean arterial pressures compared to nonsurvivors. These results suggest that early initiation of ECMO therapy for refractory sepsis is associated with better patient outcomes. ECMO is unlikely to recover patients once circulatory and metabolic collapse has developed.

Keywords

Pediatric patients - Sepsis - ECMO - ELSO


Publication History

Received: 28 April 2022

Accepted: 28 September 2022

Article published online:
24 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
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