Expanded application of extracorporeal membrane oxygenation in a pediatric surgery practice.
OBJECTIVE
To examine the breadth of application and resulting outcomes in a university-based extracorporeal membrane oxygenation (ECMO) program directed by pediatric surgeons.


BACKGROUND
Several randomized control trials have supported the use of ECMO in neonates with respiratory failure. No comparable data exist for older children and young adults who may be afflicted with a variety of uncommon conditions. The indications for ECMO in these patients remain controversial.


METHODS
Patient data were recorded prospectively and reported to the Extracorporeal Life Support Organization. These data were analyzed by indications and outcomes on all patients treated since the inception of the program.


RESULTS
Two hundred sixteen patients were treated with 225 courses of ECMO. Neonates (188 [87%]) outnumbered 28 older patients (aged 6 weeks to 22 years). Overall, 174 patients survived (81%). Sixty-four of 65 (98.5%) neonates with meconium aspiration syndrome survived. ECMO support after heart (3), lung (2), heart-lung (1), and liver (1) transplant yielded a 57% survival to discharge. ECMO also resulted in survival of patients with uncommon conditions, including severe asthma (1), hydrocarbon aspiration (1/2), congestive heart failure due to a cerebral arteriovenous malformation (1), tracheal occlusion incurred during endoscopic stent manipulation (2), meningitis (1), and viral pneumonia (3/5).


CONCLUSIONS
ECMO can potentially eliminate mortality for meconium aspiration syndrome. Survival for other causes of respiratory failure in neonates and older children, while not as dramatic, still surpasses that anticipated with conventional therapy. Moreover, survival of transplant patients has been comparable to that achieved in other children.
Langham
Max Raymond
MR
Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, J-100286, Gainesville, FL 32610-0286, USA. langham@surgery.ulf.edu
Kays
David William
DW
Beierle
Elizabeth Ann
EA
Chen
Mike K
MK
Stringfellow
Karla
K
Talbert
James Lewis
JL
D000293:Adolescent; D000328:Adult; D001784:Blood Gas Analysis; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D016896:Treatment Outcome