title: The impact of mechanical ventilation time before initiation of extracorporeal life support on survival in pediatric respiratory failure: a review of the Extracorporeal Life Support Registry.
abstract: OBJECTIVE
  To evaluate the relationship between duration of mechanical ventilation before the initiation of extracorporeal life support and the survival rate in children with respiratory failure. Extracorporeal life support has been used as a rescue therapy for >30 yrs in children with severe respiratory failure. Previous studies suggest patients who received >7-10 days of mechanical ventilation were not acceptable extracorporeal life support candidates as a result of irreversible lung damage.
  
  
  METHODS
  A retrospective review encompassing the past 10 yrs of the International Extracorporeal Life Support Organization Registry (January 1, 1999, to December 31, 2008).
  
  
  METHODS
  Extracorporeal Life Support Organization Registry database.
  
  
  METHODS
  A total of 1325 children (≥ 30 days and ≤ 18 yrs) met inclusion criteria.
  
  
  METHODS
  None.
  
  
  RESULTS
  The following pre-extracorporeal life support variables were identified as independently and significantly related to the chance of survival: 1) >14 days of ventilation vs. 0-7 days was adverse (odds ratio, 0.32; p < .001); 2) the presence of a cardiac arrest was adverse (odds ratio, 0.56; p = .001); 3) pH per 0.1-unit increase was protective (odds ratio, 1.15; p < .001); 4) oxygenation index, per 10-unit increase was adverse (odds ratio, 0.95; p = .002); and 5) any diagnosis other than sepsis was related to a more favorable outcome. Patients requiring >7-10 or >10-14 days of pre-extracorporeal life support ventilation did not have a statistically significant decrease in survival as compared with patients who received 0-7 days.
  
  
  CONCLUSIONS
  There was a clear relationship between the number of mechanical ventilation days before the initiation of extracorporeal life support and survival. However; there was no statistically significant decrease in survival until >14 days of pre-extracorporeal life support ventilation was reached regardless of underlying diagnosis. We found no evidence to suggest that prolonged mechanical ventilation should be considered as a contraindication to extracorporeal life support in children with respiratory failure before 14 days.
authors.affiliation: Department of Pediatrics, Division of Critical Care,Children's Hospital of Orange County, Orange, CA, USA. MDomico@CHOC.org
authors.forename: Michele B
authors.initials: MB
authors.lastname: Domico
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Ridout
authors.forename: Ronald
authors.initials: R
authors.lastname: Bronicki
authors.forename: Nick G
authors.initials: NG
authors.lastname: Anas
authors.forename: John Patrick
authors.initials: JP
authors.lastname: Cleary
authors.forename: James
authors.initials: J
authors.lastname: Cappon
authors.forename: Allan P
authors.initials: AP
authors.lastname: Goldman
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Brown
mesh_terms: D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D016208:Databases, Factual; D018450:Disease Progression; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D012042:Registries; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors