title: Improved outcomes of paediatric extracorporeal support associated with technology change.
abstract: This study aims to evaluate the impact of a change in extracorporeal membrane oxygenation (ECMO) technology on patient and circuit outcomes. A retrospective single-centre study of all ECMO runs from 1988 to 2006 was performed. Predictors of survival to hospital discharge (primary outcome measure) were evaluated in the entire cohort by univariate and multivariate analysis. A detailed subgroup univariate and multivariate analysis was performed in the cardiac and respiratory groups to identify predictors of survival to hospital discharge. A total of 275 patients underwent 294 extracorporeal support runs at a median (interquartile range) age of 40 (3-639) days and weight of 4.0 (3.1-10) kg. The primary indications for support were respiratory (41.8%), cardiac (45.6%) and sepsis (12.6%). Between the initial (Era 1) and most recent era (Era 3), cardiac support became the predominant ECMO indication (26 of 127 vs. 59 of 107; P<0.001). Survival to decannulation, intensive care and hospital discharge for the entire cohort and Era 3 patients were 50.0%, 48.9%, 44.4% and 71.7%, 55.6%, 52.6% (P<0.003), respectively. Treatment in Era 3 was associated with increased survival to intensive care discharge (P=0.02) for all ECMO patients. Cardiac survival was associated with treatment in Era 3 (P=0.04) and a lower complexity score (P<0.001). There was a significant reduction in mechanical circuit complications in the respiratory ECMO subgroup. A significant improvement in patient survival outcomes and reduction in mechanical circuit complications was noted in the current era. This improvement was associated with a change in ECMO technology.
authors.affiliation: Department of Intensive Care, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia. ben.sivarajan@sickkids.ca
authors.forename: V Ben
authors.initials: VB
authors.lastname: Sivarajan
authors.forename: Derek
authors.initials: D
authors.lastname: Best
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.forename: Lara S
authors.initials: LS
authors.lastname: Shekerdemian
authors.forename: Yves
authors.initials: Y
authors.lastname: D'Udekem
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Horton
authors.forename: Warwick
authors.initials: W
authors.lastname: Butt
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012131:Respiratory Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000601:surgery*; D012772:Shock, Septic / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome