title: Prolonged extracorporeal membrane oxygenation for children with respiratory failure.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation is used to support children with respiratory failure. When extracorporeal membrane oxygenation duration is prolonged, decisions regarding ongoing support are difficult as a result of limited prognostic data.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Multi-institutional data reported to the Extracorporeal Life Support Organization Registry.
  
  
  METHODS
  Patients aged 1 month to 18 yrs supported with extracorporeal membrane oxygenation for respiratory failure from 1993 to 2007 who received support for ≥ 21 days.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 3213 children supported with extracorporeal membrane oxygenation during the study period, 389 (12%) were supported ≥ 21 days. Median patient age was 9.1 months (interquartile range, 2.5-41.7 months). Median weight was 6.7 kg (interquartile range, 3.5-15.8 kg). Survival for this group was 38%, significantly lower than survival reported for children supported ≤ 14 days (61%, p < .001). Among children supported with extracorporeal membrane oxygenation for ≥ 21 days, no differences were found between survivors and nonsurvivors with regard to acute pulmonary diagnosis, pre-extracorporeal membrane oxygenation comorbidities, pre-extracorporeal membrane oxygenation adjunctive therapies, or pre-extracorporeal membrane oxygenation blood gas parameters. Only peak inspiratory pressure was significantly different in survivors. Complications occurring on extracorporeal membrane oxygenation were more common among nonsurvivors. The use of inotropic infusion (odds ratio 1.64; 95% confidence interval 1.07-2.52), acidosis (pH <7.2) during extracorporeal membrane oxygenation (odds ratio 2.62; 95% confidence interval 1.51-4.55), and male gender (odds ratio 1.95; 95% confidence interval 1.21-3.15) were independently associated with increased odds of death.
  
  
  CONCLUSIONS
  Survival declines with duration of extracorporeal membrane oxygenation. Male gender and inadequate cardiorespiratory status during extracorporeal membrane oxygenation increased the risk of death. Prolonged support with extracorporeal membrane oxygenation appears reasonable unless multiorgan failure develops.
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Brogan
authors.forename: Luke
authors.initials: L
authors.lastname: Zabrocki
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: Peter T
authors.initials: PT
authors.lastname: Rycus
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
mesh_terms: D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors