Extracorporeal membrane oxygenation in the treatment of respiratory failure in pediatric patients with burns.
Extracorporeal membrane oxygenation (ECMO) as a treatment for pulmonary failure from postshock respiratory distress in burned children recently has been shown to salvage patients who were thought to have more than a 90% chance of dying. We describe five burned children in whom severe respiratory failure--not responsive to medical management and maximal ventilatory support--developed, and who underwent ECMO treatment. Three (60%) cases involved flame burns, with significant inhalation injury as diagnosed after a bronchoscopy; mean age was 3 years (2 to 4 years), with a mean total body surface area (TBSA) burn of 32% (15% to 53%), mean third-degree burns of 25% (5% to 53%). Two (40%) cases involved scald burns; mean age was 6 years (7 months to 11 years), with a mean TBSA burn of 56.5% (43% to 70%), mean third-degree burns of 40% (10.5% to 70%). Outcome was poor for those burned children who received ECMO therapy after prolonged ventilatory support for smoke inhalation injury. Children who experience perfusion/reperfusion shock injury to the lungs as a result of delayed resuscitation of scald burns may have an improved chance of survival with short courses of ECMO regardless of the burn size.
Pierre
E J
EJ
Shriners Hospitals for Children, Galveston Unit, and the Department of Anesthesia, University of Texas Medical School, USA.
Zwischenberger
J B
JB
Angel
C
C
Upp
J
J
Cortiella
J
J
Sankar
A
A
Herndon
D N
DN
D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007223:Infant; D008297:Male; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D012151:Resuscitation; D015996:Survival Rate; D016896:Treatment Outcome