title: Outcomes in children with refractory pneumonia supported with extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  To review the use of extracorporeal membrane oxygenation (ECMO) in severe paediatric pneumonia and evaluate factors that may affect efficacy of this treatment.
  
  
  METHODS
  Retrospective study of the ECMO database of a tertiary paediatric intensive care unit and chart review of all patients who were managed with ECMO during their treatment for severe pneumonia over a 23-year period. The main outcome measures were survival to hospital discharge, and ICU and hospital length of stay. We compared the groups of culture-positive versus culture-negative pneumonia, venoarterial (VA) versus venovenous (VV) ECMO, community- versus hospital-acquired cases, and cases before and after 2005.
  
  
  RESULTS
  Fifty patients had 52 cases of pneumonia managed with ECMO. Community-acquired cases were sicker with higher oxygenation index (41.5 ± 20.5 versus 26.8 ± 17.8; p = 0.031) and higher inotrope score [20 (5-37.5) versus 7.5 (0-18.8); p = 0.07]. Use of VA compared with VV ECMO was associated with higher inotrope scores [20 (10-50) versus 5 (0-20); p = 0.012]. There was a trend towards improved survival in the VV ECMO group (82.4 versus 62.9 %; p = 0.15). Since 2005, patients have been older [4.7 (1-8) versus 1.25 (0.15-2.8) years; p = 0.008] and survival has improved (88.2 versus 60.0 %; p = 0.039).
  
  
  CONCLUSIONS
  Survival in children with pneumonia requiring ECMO has improved over time and is now 90 % in the modern era. Risk factors for death include performing a circuit change [odds ratio (OR) 5.0; 95 % confidence interval (CI) 1.02-24.41; p = 0.047] and use of continuous renal replacement therapy (OR 4.2; 95 % CI 1.13-15.59; p = 0.032).
authors.affiliation: Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia. nathansmalley@me.com
authors.forename: Nathan
authors.initials: N
authors.lastname: Smalley
authors.forename: Graeme
authors.initials: G
authors.lastname: MacLaren
authors.forename: Derek
authors.initials: D
authors.lastname: Best
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.forename: Warwick
authors.initials: W
authors.lastname: Butt
mesh_terms: D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index