title: Extracorporeal membrane oxygenation support among children with adenovirus infection: a review of the Extracorporeal Life Support Organization registry.
abstract: Overwhelming adenovirus infection requiring extracorporeal membrane oxygenation (ECMO) support carries a high mortality in pediatric patients. The objective of this study was to retrospectively review data from the Extracorporeal Life Support Organization (ELSO) registry for pediatric patients with adenovirus infection and define for this patient cohort: 1) clinical characteristics, 2) survival to hospital discharge, and 3) factors associated with mortality before hospital discharge. In this retrospective registry study, pediatric patients with adenovirus infection requiring ECMO support identified in an international ECMO registry from 1998 to 2009 were compared for clinical characteristics (demographics, pre-ECMO variables, and complications on ECMO) between survivors and nonsurvivors to hospital discharge. Descriptive statistics and univariate and multivariate logistic analysis were used to compare clinical characteristics among survivors and nonsurvivors. For children requiring ECMO support for adenovirus, the survival at hospital discharge is 38% (62/163). Among neonates (<31 days of age), the survival at hospital discharge was only 11% (6/54). Among patient factors, neonatal age (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.62-10.87), a decrease of 0.1 unit in pre-ECMO pH (OR, 1.77; 95% CI, 1.3-2.42), the presence of sepsis (OR, 4.55; 95% CI, 1.47-14.15), and increased peak inspiratory pressures (OR, 1.04; 95% CI, 1.01-1.08) were all independently associated with in-hospital mortality. ECMO complications independently associated with in-hospital mortality were presence of pneumothorax (OR, 3.57; 95% CI, 1.19-10.7), pH less than 7.2 (OR, 5.94; 95% CI, 1.04-34.1), and central nervous system hemorrhage (OR, 25.36; 95% CI, 1.47-436.7). In this retrospective cohort study of pediatric patients with adenovirus infection supported on ECMO, survival to hospital discharge was 38% but was much lower in neonates. Neonatal presentation, degree of acidosis, sepsis, and increased PIP are factors present before decisions are made regarding a trial of ECMO, whereas pneumothorax and brain hemorrhage were ECMO-related complications independently associated with mortality.
authors.affiliation: From the *Department of Pediatrics, Division of Pediatric Critical Care, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; †Department of Pediatrics, Division of Pediatric Cardiology, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; ‡Department of Pediatrics, Division of Biostatistics, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, Arkansas; §The Extracorporeal Life Support Organization Registry, Ann Arbor, Michigan; and ¶Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, Utah.
authors.forename: Parthak
authors.initials: P
authors.lastname: Prodhan
authors.forename: Adnan T
authors.initials: AT
authors.lastname: Bhutta
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Gossett
authors.forename: Michael H
authors.initials: MH
authors.lastname: Stroud
authors.forename: Peter T
authors.initials: PT
authors.lastname: Rycus
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
authors.forename: Richard T
authors.initials: RT
authors.lastname: Fiser
mesh_terms: D000258:Adenovirus Infections, Human / Q000401:mortality* / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012042:Registries; D055815:Young Adult