Journal of pediatric surgery · 2025
Pediatric ECMO Outcomes in Children With Severe Infections: Does Infectious Source Matter?
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Zens Tiffany, Lara Brian, Ochoa Brielle, Eldredge Richard S, Gregory Melinda, Molitor Mark S
Аннотация
BACKGROUND: Although Extracorporeal Membrane Oxygenation (ECMO) utilization in pediatric patients with cardiopulmonary failure due to infection improves mortality, it is unclear whether the infectious etiology impacts outcomes. The aim of this study is to compare ECMO outcomes in children with sepsis and severe acute lung injury secondary to infections based on culture data.
METHODS: A retrospective review was done of patients aged <18 with severe infections whose management included ECMO from 2013 to 2022 at a quaternary children's hospital. Respiratory and blood cultures were reviewed. Mortality for all groups was compared using univariate and multivariate models.
RESULTS: A total of 155 patients were included. Overall mortality on ECMO was 36 % and mortality at discharge was 51 %. Using a Cox proportional hazards regression, patients with both positive blood and respiratory cultures at time of cannulation had an adjusted HR (Hazard Ratio) for mortality on ECMO of 7.65 (95 % CI 1.92-30.44, p = 0.004) and adjusted HR for mortality at discharge of 4.48 (95 % CI 1.69-11.88, p = 0.003) compared to those with only positive bacterial respiratory cultures. There was increased mortality on ECMO for patients with more than one virus identified on viral respiratory panel [HR 6.1 (CI 1.1-32.9, p = 0.03)], but no difference in mortality of patients with polymicrobial bacterial pneumonias. There was no relationship between bacterial organism and mortality, but patients with RSV and COVID viral infections demonstrated higher mortality.
CONCLUSIONS: ECMO outcomes in pediatric patients with cardiopulmonary failure secondary to infection differ based on the infectious source. This information is important when discussing prognosis with families prior to cannulation.
STUDY TYPE/LEVEL OF EVIDENCE: Retrospective Review, Cohort study.
METHODS: A retrospective review was done of patients aged <18 with severe infections whose management included ECMO from 2013 to 2022 at a quaternary children's hospital. Respiratory and blood cultures were reviewed. Mortality for all groups was compared using univariate and multivariate models.
RESULTS: A total of 155 patients were included. Overall mortality on ECMO was 36 % and mortality at discharge was 51 %. Using a Cox proportional hazards regression, patients with both positive blood and respiratory cultures at time of cannulation had an adjusted HR (Hazard Ratio) for mortality on ECMO of 7.65 (95 % CI 1.92-30.44, p = 0.004) and adjusted HR for mortality at discharge of 4.48 (95 % CI 1.69-11.88, p = 0.003) compared to those with only positive bacterial respiratory cultures. There was increased mortality on ECMO for patients with more than one virus identified on viral respiratory panel [HR 6.1 (CI 1.1-32.9, p = 0.03)], but no difference in mortality of patients with polymicrobial bacterial pneumonias. There was no relationship between bacterial organism and mortality, but patients with RSV and COVID viral infections demonstrated higher mortality.
CONCLUSIONS: ECMO outcomes in pediatric patients with cardiopulmonary failure secondary to infection differ based on the infectious source. This information is important when discussing prognosis with families prior to cannulation.
STUDY TYPE/LEVEL OF EVIDENCE: Retrospective Review, Cohort study.