[II-JCKAP5-2-2] Consideration of Optimal Timing for Initiation of Veno-Venous Extracorporeal Membrane Oxygenation in Neonatal and Pediatric Respiratory Failure
Keywords:Extracorporeal Membrane Oxygenation, Respiratory Distress Syndrome, Pediatric
Objective
VV-ECMO guidelines for pediatric respiratory distress syndrome (RDS) patients still seems unclear. We aimed to clarify optimal timing to initiate the VV-ECMO in pediatric RDS patients based on our clinical experience.
Methods
RDS patients requiring VV-ECMO support (December 2016 and February 2024) were retrospectively reviewed. Patients were divided into two groups, mortality and survival cases. We reviewed various clinical parameters, including oxygen index (OI) values in peri-ECMO support period and analyzed outcomes.
Results
32 patients were enrolled. The median age of the patients was 3.4 years (Interquartile range [IQR], 0.7-6.0 years), and body surface area was 0.63 m2 (IQR, 0.32-0.76) at the time of ECMO insertion. The median duration of VV-ECMO support was 9.5 days (IQR, 4.8-32 days). 13 patients (40.6%) survived. OI at the time of VV-ECMO support started (19.9 [IQR:10.8-43.9] in survivors vs. 39.0 [IQR:26.7-62.7] in deceased, p-value=0.03) and at 8 hours before initiation of ECMO was significantly lower in the survivor group (15.6 [IQR:12.9-24.0] in survivors vs. 31.5 [IQR:19.5-45.8] in deceased, p-value=0.008). PaO2 and mechanical ventilation duration showed no significant differences between groups. Including anticoagulation-related complications, there were no major complications during ECMO support.
Conclusion
In pediatric RDS patients, regular monitoring of OI seemed essential to determine appropriate timing for initiating ECMO. With little risks in maintaining VV-ECMO, we should consider earlier initiation of VV-ECMO support than we have done so far.
VV-ECMO guidelines for pediatric respiratory distress syndrome (RDS) patients still seems unclear. We aimed to clarify optimal timing to initiate the VV-ECMO in pediatric RDS patients based on our clinical experience.
Methods
RDS patients requiring VV-ECMO support (December 2016 and February 2024) were retrospectively reviewed. Patients were divided into two groups, mortality and survival cases. We reviewed various clinical parameters, including oxygen index (OI) values in peri-ECMO support period and analyzed outcomes.
Results
32 patients were enrolled. The median age of the patients was 3.4 years (Interquartile range [IQR], 0.7-6.0 years), and body surface area was 0.63 m2 (IQR, 0.32-0.76) at the time of ECMO insertion. The median duration of VV-ECMO support was 9.5 days (IQR, 4.8-32 days). 13 patients (40.6%) survived. OI at the time of VV-ECMO support started (19.9 [IQR:10.8-43.9] in survivors vs. 39.0 [IQR:26.7-62.7] in deceased, p-value=0.03) and at 8 hours before initiation of ECMO was significantly lower in the survivor group (15.6 [IQR:12.9-24.0] in survivors vs. 31.5 [IQR:19.5-45.8] in deceased, p-value=0.008). PaO2 and mechanical ventilation duration showed no significant differences between groups. Including anticoagulation-related complications, there were no major complications during ECMO support.
Conclusion
In pediatric RDS patients, regular monitoring of OI seemed essential to determine appropriate timing for initiating ECMO. With little risks in maintaining VV-ECMO, we should consider earlier initiation of VV-ECMO support than we have done so far.