Successful use of extracorporeal membrane oxygenation to treat severe respiratory failure in a pediatric patient with a scald injury.
If ECMO is to be used effectively in pediatric patients, specifically in those with burns, the candidates must be chosen with care. Unlike the situation in neonates, when ECMO is being considered for use in a pediatric patient, no clear set of inclusion or exclusion criteria exists. Evaluation of a pediatric patient for ECMO support is largely based on an assessment of the patient's condition and a center's previous experience with pediatric ECMO. The data that are available through ELSO indicate that survival decreases as the number of days a patient receives mechanical ventilation before the initiation of ECMO increases. The effect of burns on patients' outcomes is unknown. Age, duration of mechanical ventilation, and excision with allografting or homografting of the burns should all be considered before the patient is offered ECMO support. The remaining prognostic signs--duration of ECMO support, frequency of complications, and blood product requirements--are available only after the ECMO course is under way or completed. The success of our center and others in using ECMO to treat respiratory failure associated with burns shows that some patients with burns may benefit from ECMO. Unfortunately, no specific set of criteria exists that would enable ECMO centers to differentiate good candidates from poor ones and thus be able to offer ECMO support with confidence in its benefit for the patient.
Hilt
T
T
ECMO Program, University of Texas Medical Branch, Galveston, USA.
Graves
D F
DF
Chernin
J M
JM
Angel
C A
CA
Herndon
D N
DN
Zwischenberger
J B
JB
D002056:Burns / Q000150:complications*; D003422:Critical Care / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods* / Q000451:nursing*; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D010347:Patient Care Planning; D018579:Patient Selection; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*