[ECMO: experience in paediatrics].
BACKGROUND
ECMO (Extracorporeal Membrane Oxygenation) provides a vital support to patients with supposed reversible respiratory and/or cardiac failure, in whom conventional support techniques have been previously unsuccessful.


OBJECTIVE
To determinate the criteria used in our hospital to put paediatric patients on ECMO, compare their clinical course depending on their pathology (respiratory failure, congenital heart disease or sepsis) and identify the sequelae attributable to this technique.


METHODS
A retrospective review of clinical records of all patients on ECMO support in our centre, excluding those presenting typically in neonatal period.


RESULTS
ECMO was used on 16 patients from June 2001 to January 2007, of which 50% were males. The median age was 7 months (from 21 days to 11 years). The reason for starting ECMO was respiratory failure in 11 cases (oxygenation index >40 and/or alveolar-arterial oxygen gradient >605), congenital heart disease in 2 and sepsis in 3 (due to shock unresponsive to adequate resuscitation). The median time to starting ECMO from PICU admission was 3.58 days (from 12h to 9 days). Venovenous cannulation was used initially in 8 patients, but 5 of them needed venoarterial ECMO later. The technique was used for a mean of 8 days (from 1 to 28 days). The main complication was the isolation of bacteria in different cultures (8 patients). The overall survival was 50% (6 patients with respiratory failure and both patients submitted to cardiac surgery). Extracorporeal support was withdrawn in 7 children because their clinical situation was irreversible. Another patient died seven days after successful decannulation. We have not found any serious sequel among survivors that could be attributable to this technique.


CONCLUSIONS
Survival among children supported with ECMO in our hospital is similar to that recorded by the ELSO in 2004, although the prognosis depends on the initial pathology. There are different criteria for starting this technique depending on the underlying diseases: respiratory index of poor prognosis in patients with respiratory failure, haemodynamic instability in those with sepsis or cardiac failure after cardiovascular surgery. We have not found any serious sequel among the survivors which could be attributable to this technique.
Segura
S
S
Servicio de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu-Clínic, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España. ssegura@hsjdbcn.org
Cambra
F J
FJ
Moreno
J
J
Thió
M
M
Riverola
A
A
Iriondo
M
M
Mayol
J
J
Palomeque
A
A
D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D018805:Sepsis / Q000628:therapy*