Influencing factors of extracorporeal membrane oxygenation on outcomes in critically ill children

Abstract

Objective To summarize the clinical features of extracorporeal membrane oxygenation (ECMO) in pediatric intensive care unit (PICU) in a single center and analyze the influencing factors of clinical outcomes so as to provide experience for pediatric ECMO management. Methods A case-control trial was carried out on 35 children undergoing ECMO support from May 2018 to January 2022 in our department. According to the clinical outcomes, they were divided into survival group (n=22) and death group (n=13). Duration of mechanical ventilation, Pediatric Risk of Mortality Ⅲ (PRISM Ⅲ) score and results of laboratory tests before ECMO support, and incidence rates of comorbidities and/or complications during ECMO support were compared between the 2 groups. Univariate analysis and logistic regression analysis were used to explore the influencing factors of clinical outcomes in children with ECMO support. Results There were no significant differences in age distribution, gender, primary diseases, PICU hospitalization time, hospitalization cost, ECMO support mode, and potential of hydrogen (pH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), blood urea nitrogen (BUN), lactic acid (Lac), partial activated thromboplastin time (APTT) and prothrombin time (PT) before ECMO support between the 2 groups (all P>0.05). Compared with the survival group, the death group had lower body weight (P=0.004), higher PRISM Ⅲ score (P=0.001), longer duration of mechanical ventilation (P=0.009) and lower oxygenation index (OI) (P=0.039) before ECMO, and higher incidence of concomitant and/or combined acute kidney injury (AKI) (P=0.032) and higher use of renal replacement therapy during ECMO (P=0.024). Multivariate logistic regression analysis showed that PRISM Ⅲ score before ECMO support (OR=1.482, 95%CI: 1.043~2.105, P=0.028) and concomitant and/or combined AKI during ECMO (OR=0.055, 95%CI: 0.004~0.676, P=0.023) were independent risk factors for death in critically ill children supported by ECMO. Conclusion PRISM Ⅲ score before ECMO operation and concomitant and/or combined AKI during ECMO are independent risk factors for predicting death in critically ill children with ECMO support.

Keywords

• extracorporeal membrane oxygenation
• children
• critical illness
• influencing factors