title: Long-Term Survival and Causes of Late Death in Children Treated With Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation has been used in patients with severe circulatory or respiratory failure since the 1970s, but the knowledge on long-term survival in this group is scarce. The aim of the present study was to investigate the 10-year survival rates and causes of late death in children treated with extracorporeal membrane oxygenation.
  
  
  METHODS
  Single-center, retrospective cohort study.
  
  
  METHODS
  Tertiary referral center for extracorporeal life support.
  
  
  METHODS
  Neonatal and pediatric patients treated with extracorporeal membrane oxygenation from 1987 to December 2013.
  
  
  METHODS
  None.
  
  
  RESULTS
  Survival status was obtained from the national Causes of Death registry. Patient background data along with data on survival and causes of death were collected. Survival rates were calculated using the Kaplan-Meier method. Of 400 subjects, 76% survived to discharge. The median follow-up time in survivors was 7.2 years. There was a high mortality rate within the first months after discharge. In the group of patients who survived the first 90 days after treatment, the 10-year survival rates were 93% in neonates and 89% in pediatric patients and were particularly beneficial in patients whose indication for extracorporeal membrane oxygenation was meconium aspiration syndrome, trauma, or infectious diseases. Late deaths were seen in some diagnostic groups, but the Kaplan-Meier curves plateaued over time.
  
  
  CONCLUSIONS
  Children who survive the first months after treatment with extracorporeal membrane oxygenation have a high long-term survival rate. The prognosis is especially favorable in patients with reversible conditions.
authors.affiliation: 1Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden. 2ECMO Center Karolinska, ECMO Department, Karolinska University Hospital, Stockholm, Sweden. 3Childhood Cancer Research Unit Q6:05, Department of Women's and Children's Health, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden. 4Department of Anesthesiology and Intensive Care, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark. 5Department of Women's and Children's Health, Pediatric Surgery, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden.
authors.forename: Viktor
authors.initials: V
authors.lastname: von Bahr
authors.forename: Jan
authors.initials: J
authors.lastname: Hultman
authors.forename: Staffan
authors.initials: S
authors.lastname: Eksborg
authors.forename: Roxana
authors.initials: R
authors.lastname: Gerleman
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Enstad
authors.forename: Björn
authors.initials: B
authors.lastname: Frenckner
authors.forename: Håkan
authors.initials: H
authors.lastname: Kalzén
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D053208:Kaplan-Meier Estimate; D008297:Male; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012769:Shock / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate