What is the morbidity and mortality associated with pediatric ECMO?

Updated: Dec 21, 2017
  • Author: Edwin Rodriguez-Cruz, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Answer

Mortality statistics of ECMO-treated patients have remained stable over the past decade. Predictors of death include the following:

  • Patients with a primary diagnosis of congenital diaphragmatic hernia (CDH) and total anomalous pulmonary venous returns (TAPVR) have a mortality rate of 50%

  • Approximately 50% of reported deaths are due to severe bleeding complications

  • The mortality rate is high in infants with a birth weight less than 2000 g

Barbaro et al investigated whether higher annual extracorporeal membrane oxygenation (ECMO) patient volume is associated with lower case-mix-adjusted hospital mortality rate. They retrospectively analyzed an international registry of ECMO support from 1989 to 2013. The primary outcome was death before hospital discharge. From 1989 to 2013, 290 centers provided ECMO support to 56,222 patients (30,909 neonates, 14,725 children, and 10,588 adults). Across ECMO centers, annual ECMO mortality rates varied widely. The interquartile range was 18-50% for neonates, 25-66% for pediatrics, and 33-92% for adults. For 1989-2013, higher age group-specific ECMO volume was associated with lower odds of ECMO mortality for neonates and adults. In 2008-2013, the volume-outcome association remained statistically significant only among adults. [20]

Infants who survive following ECMO have a higher rate of rehospitalization for nonpulmonary and surgical conditions. Approximately 15% of infants still require oxygen at 28 days after ECMO. These children have a higher rate of rehospitalization for pulmonary indications, particularly in the first 6 months after ECMO, and have a slightly higher prevalence of bronchial asthma.

Difficulty in establishing full oral feeding is common after ECMO decannulation; feeding difficulty is reported in as many as one third of babies, even in the presence of normal suck and swallow reflexes. Somatic growth is normal in infants who survive following ECMO, and poor growth should be evaluated for another underlying cause.

Both clinical and electroencephalographic seizure activity is reported in 20-70% of neonates while on ECMO. Epilepsy is reported in 2% of patients at age 5 years.


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