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Pediatr Surg Int. 2019 Mar;35(3):321-328. doi: 10.1007/s00383-019-04443-y. Epub 2019 Jan 25.

Outcomes and associated ethical considerations of long-run pediatric ECMO at a single center institution.

Author information

1
Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 211 E Chicago Avenue, Box 63, Chicago, IL, 60611, USA.
2
Department of Surgery, University of Illinois at Chicago, 840 South Wood Street, Suite 376-CSN, Chicago, IL, 60612, USA.
3
Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL, 60611, USA.
4
Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 211 E Chicago Avenue, Box 63, Chicago, IL, 60611, USA. Chunter@luriechildrens.org.
5
Feinberg School of Medicine, Northwestern University, 310 East Superior Street, Morton 4-685, Chicago, IL, 60611, USA. Chunter@luriechildrens.org.

Abstract

PURPOSE:

Survival of neonatal and pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) ≥ 21 days has not been well described. We hypothesized that patients would have poor survival and increased long-term complications.

METHODS:

Retrospective, single center, review and case analysis. Tertiary-care university children's hospital including neonatal, pediatric and cardiac intensive care units. After institutional review board approval, the charts of all patients < 18 years of age undergoing ECMO for ≥ 21 continuous days were performed, and they were compared to comparative patients undergoing shorter runs. Overall survival, incidence of complications, and post-discharge recovery were recorded.

RESULTS:

Overall survival was 36% in patients undergoing ≥ 21 days of ECMO (N = 14). 5/8 patients with cardiopulmonary failure from acquired etiologies survived versus 0/6 patients with congenital anomalies. 1/5 survivors achieved complete recovery with no neurologic deficits. The remaining survivors suffer from multiple medical and neurodevelopmental morbidities.

CONCLUSION:

ECMO support for ≥ 21 days is associated with poor survival, particularly in neonates with congenital anomalies. Long-term outcomes for survivors ought to be carefully weighed and discussed with parents given the high incidence of neurologic morbidities in this population.

KEYWORDS:

Long-run; Moral distress, Ethics; Neonatal ECMO; Neurodevelopmental outcome; Pediatric ECMO

PMID:
30683989
PMCID:
PMC6433597
DOI:
10.1007/s00383-019-04443-y
[Indexed for MEDLINE]
Free PMC Article

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