title: Extubation during pediatric extracorporeal membrane oxygenation: a single-center experience.
abstract: OBJECTIVE
  Describe aspects of one center's experience extubating infants and children during extracorporeal membrane oxygenation.
  
  
  METHODS
  Retrospective review of medical records.
  
  
  METHODS
  Seventy-one-bed critical care service (PICU and cardiovascular ICU) in a large urban tertiary children's hospital.
  
  
  METHODS
  Pediatric and neonatal patients supported on extracorporeal membrane oxygenation between 1996 and 2013 who were either not intubated or extubated greater than 24 hours during their extracorporeal membrane oxygenation course.
  
  
  METHODS
  None.
  
  
  RESULTS
  Sixteen of 511 patients on extracorporeal membrane oxygenation were extubated for at least 24 hours during their extracorporeal membrane oxygenation courses. Fourteen had respiratory failure and two had cardiac disease. Five patients died while on extracorporeal membrane oxygenation, but the cause of death was not related to complications associated with extubation. Extubated patients were supported a median of 19.7 days on extracorporeal membrane oxygenation, with a median extubation latency (time between cannulation and first extubation) of 6.2 days and a median extubation duration of 5.5 days. Mean time extubated was 43% of the total time on extracorporeal membrane oxygenation. Two patients were reintubated briefly or had a laryngeal mask airway placed for decannulation (n = 1). The remaining patients were extubated within 5 days of decannulation, weeks afterward (n = 2), transferred to outside facilities (n = 2), or died during extracorporeal membrane oxygenation support (n = 5). We also observed no complications directly attributable to extubation and spontaneous reaeration of consolidated lungs in acute respiratory distress syndrome in extubated patients on extracorporeal membrane oxygenation.
  
  
  CONCLUSIONS
  Extubation and discontinuation of mechanical ventilation appear feasible in patients requiring long-term extracorporeal membrane oxygenation. Emergency procedure planning may need to be modified in extubated patients on extracorporeal membrane oxygenation.
authors.affiliation: 1Department of Pediatrics, Division of Pediatric Critical Care, University of Texas Southwestern Medical Center, Dallas, TX. 2Department of Pediatrics, Division of Pediatric Critical Care, University of Missouri, Kansas City/Children's Mercy Hospital, Kansas City, MO. 3Division of Pediatric Surgery, William Beaumont Oakland University Medical School, Royal Oak, MI. 4Department of Critical Care Services, Children's Medical Center, Dallas, TX. 5Department of Pediatrics, Section of Pediatric Critical Care, Baylor College of Medicine/Texas Children's Hospital, Houston, TX.
authors.forename: Pilar
authors.initials: P
authors.lastname: Anton-Martin
authors.forename: Marita T
authors.initials: MT
authors.lastname: Thompson
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sheeran
authors.forename: Anne C
authors.initials: AC
authors.lastname: Fischer
authors.forename: Donna
authors.initials: D
authors.lastname: Taylor
authors.forename: James A
authors.initials: JA
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D060666:Airway Extubation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D012189:Retrospective Studies; D062606:Tertiary Care Centers