The Use of Extracorporeal Membrane Oxygenation in 16 Children with Acute Respiratory Distress Syndrome: A Retrospective Observational Study

Abstract

Background: Acute respiratory distress syndrome (ARDS) is one of the common causes of death in children hospitalized in the pediatric intensive care unit (PICU). The overall case fatality rate is as high as 25%, and the case fatality rate is higher in severe cases. Objectives: This study aimed to analyze the clinical outcomes of extracorporeal membrane oxygenation (ECMO) supportive therapy in children with ARDS. Methods: Sixteen ARDS children (8 boys and 8 girls aged 0.17 to 10 years old, with an average age of 3.25 years) were enrolled in this retrospective observational study. They were admitted to the PICU of a tertiary children’s hospital in China between January 2017 and March 2020. All patients received venous-arterial ECMO (veno-arterial, V-A ECMO) mode and were treated with heparin-coated ECMO-specific intravenous 8 - 19 Fr. catheter. Data were collected from medical records. General characteristics included gender, age, body weight, ventilator use before ECMO establishment, ECMO operation mode, ECMO operation hours, number of fiberoptic bronchoscopy assisted treatments, days on the ventilator after ECMO evacuation, total days on the ventilator, days of hospitalization, pathogen infection, primary disease/underlying disease, complications during ECMO therapy, comparison of monitored values of children 1 hour before and after ECMO establishment, analysis of the causes of complications during ECMO treatment in ARDS children. Results: The time in 16 cases of ECMO support ranged from 92 to 759 hours, with an average time of 255.13 hours. All patients survived the ECMO treatment, except for 1 case who died due to intracranial bleeding. Monitoring values, such as FiO2, mean airway pressure (MAP), blood pH, partial pressure of carbon dioxide (PCo2), etc., were statistically significantly different before and after ECMO establishment. There were 34 person-time complications during ECMO operation, among which hypertension was the most common. At follow-up (1 month to 3 years, until February 2020), 15 children were found to have good lung function. Conclusions: Early ECMO-assisted treatment in children with ARDS can improve their survival rate.