Project Title

ECMO Support for Pediatric Burn Patients: A Potential Life Saving Modality

Authors' Affiliations

Fakhry Dawoud, Quillen College of Medicine East Tennessee State University, Johnson City, TN

Location

Clinch Mtn

Start Date

4-12-2019 9:00 AM

End Date

4-12-2019 2:30 PM

Poster Number

172

Faculty Sponsor’s Department

Family Medicine

Name of Project's Faculty Sponsor

Dr. Joe Florence

Type

Poster: Competitive

Classification of First Author

Medical Student

Project's Category

Cardiovascular System, Respiratory System, Burns

Abstract Text

Extracorporeal membrane oxygenation (ECMO) has been used as life-saving support for children with varying causes of respiratory and/or cardiac failure. However, few studies have assessed the utility of ECMO as a viable treatment option in the setting of pediatric burn injury. We aim to examine the outcomes of pediatric burn patients requiring ECMO support by utilizing the Extracorporeal Life Support Organization (ELSO) registry in order to elucidate whether or not ECMO should be considered in this population.

A retrospective cohort study was conducted by querying the ELSO database for all pediatric patients (birth to less than 18 years) who were supported on ECMO with burn-associated cardiopulmonary failure between 1990 and 2016. ICD-9 codes 940–949.5 were utilized to identify patients with an associated burn injury. Venovenous ECMO was defined as any patient with only venous cannulas, including double-lumen venous cannulas. Venoarterial ECMO was defined as any patient with a venous and an arterial cannula, any patient originally supported on VA ECMO that was converted to venovenous, or any patient originally supported on venovenous that was converted to venoarterial ECMO. Oxygenation indices (OI) and complication rates were compared among survivors and non-survivors for both venovenous (VV) and venoarterial (VA) groups. Primary outcome variables were survival and non-survival to hospital discharge. Demographic and clinical data, along with pre-ECMO variables and ECMO complications, were analyzed for predictive mortality.

A total of 113 patients met inclusion criteria for the study. Overall survival to discharge was 52.2% (n=59) for the entire cohort. 73 patients were supported on VA ECMO, while 37 patients required VV ECMO support with a survival to discharge of 47.9% (n=35) and 62.2% (n=23), respectively. There was no statistical difference for median age (p=0.765), median weight (p=0.932), or median hours on ECMO (p=0.963) between survivors and non-survivors. Three patients did not have the type of cannulation identified but were listed as “other” in the ELSO registry. Patients requiring ECMO support for respiratory failure had a higher over-all survival (55.7%, n=97) compared to those requiring ECMO for cardiac failure (33.3%, n=6) or ECPR (30%, n=10). Patients who were supported on VV ECMO for respiratory failure had the best overall survival at 62.2% (n=37) and those cannulated to VA ECMO for respiratory failure had a survival of 51.7% (n=58). Patients supported on VA ECMO for cardiac failure or ECPR support had the same survival at 33.3% (n=6 and 9 respectively). Several factors were found to be significantly associated with mortality. Cardiac arrest prior to cannulation was associated with increased mortality with an odds ratio of 3.41 (95% CI 1.29-9.06, p=0.011). There was a trend for the use of nitric oxide prior to cannulation to be associated with a decrease in mortality with an odds ratio of 0.40 (95% CI 0.16-1.01, p=0.048)Following cannulation, complications including the need for inotropes (OR 2.64, 95% CI 1.24-5.65, p=0.011), presence of gastrointestinal hemorrhage (p=0.049), and hyperglycemia (glucose > 240mg/dL) (OR 3.42, 95% CI 1.13-10.38, p=0.024) were associated with increased mortality.

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Apr 12th, 9:00 AM Apr 12th, 2:30 PM

ECMO Support for Pediatric Burn Patients: A Potential Life Saving Modality

Clinch Mtn

Extracorporeal membrane oxygenation (ECMO) has been used as life-saving support for children with varying causes of respiratory and/or cardiac failure. However, few studies have assessed the utility of ECMO as a viable treatment option in the setting of pediatric burn injury. We aim to examine the outcomes of pediatric burn patients requiring ECMO support by utilizing the Extracorporeal Life Support Organization (ELSO) registry in order to elucidate whether or not ECMO should be considered in this population.

A retrospective cohort study was conducted by querying the ELSO database for all pediatric patients (birth to less than 18 years) who were supported on ECMO with burn-associated cardiopulmonary failure between 1990 and 2016. ICD-9 codes 940–949.5 were utilized to identify patients with an associated burn injury. Venovenous ECMO was defined as any patient with only venous cannulas, including double-lumen venous cannulas. Venoarterial ECMO was defined as any patient with a venous and an arterial cannula, any patient originally supported on VA ECMO that was converted to venovenous, or any patient originally supported on venovenous that was converted to venoarterial ECMO. Oxygenation indices (OI) and complication rates were compared among survivors and non-survivors for both venovenous (VV) and venoarterial (VA) groups. Primary outcome variables were survival and non-survival to hospital discharge. Demographic and clinical data, along with pre-ECMO variables and ECMO complications, were analyzed for predictive mortality.

A total of 113 patients met inclusion criteria for the study. Overall survival to discharge was 52.2% (n=59) for the entire cohort. 73 patients were supported on VA ECMO, while 37 patients required VV ECMO support with a survival to discharge of 47.9% (n=35) and 62.2% (n=23), respectively. There was no statistical difference for median age (p=0.765), median weight (p=0.932), or median hours on ECMO (p=0.963) between survivors and non-survivors. Three patients did not have the type of cannulation identified but were listed as “other” in the ELSO registry. Patients requiring ECMO support for respiratory failure had a higher over-all survival (55.7%, n=97) compared to those requiring ECMO for cardiac failure (33.3%, n=6) or ECPR (30%, n=10). Patients who were supported on VV ECMO for respiratory failure had the best overall survival at 62.2% (n=37) and those cannulated to VA ECMO for respiratory failure had a survival of 51.7% (n=58). Patients supported on VA ECMO for cardiac failure or ECPR support had the same survival at 33.3% (n=6 and 9 respectively). Several factors were found to be significantly associated with mortality. Cardiac arrest prior to cannulation was associated with increased mortality with an odds ratio of 3.41 (95% CI 1.29-9.06, p=0.011). There was a trend for the use of nitric oxide prior to cannulation to be associated with a decrease in mortality with an odds ratio of 0.40 (95% CI 0.16-1.01, p=0.048)Following cannulation, complications including the need for inotropes (OR 2.64, 95% CI 1.24-5.65, p=0.011), presence of gastrointestinal hemorrhage (p=0.049), and hyperglycemia (glucose > 240mg/dL) (OR 3.42, 95% CI 1.13-10.38, p=0.024) were associated with increased mortality.