Clinical Characteristics and Outcomes of Children With Extracorporeal Membrane Oxygenation in a Developing Country: An 11-Year Single-Center Experience

Abstract

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving procedure for patients with refractory cardiac or respiratory failure. The indications for ECMO are growing, and it is increasingly being used to support cardiopulmonary failure in children. However, the risks and benefits of ECMO should be weighed before deploying it on the patients. The objectives of this study were to identify the mortality risk factors and to determine the ECMO outcomes.Methods: The retrospective chart reviews were done for all patients aged 1 day−20 years old receiving ECMO between January 2010 and December 2020.Results: Seventy patients were enrolled in the study. The median age was 31.3 months. The incidence of VA and VV ECMO was 85.7 and 14.3%, respectively. The most common indication for ECMO was the failure to wean off cardiopulmonary bypass after cardiac surgery. Pre-existing acute kidney injury (OR 4.23; 95% CI 1.34–13.32, p = 0.014) and delayed enteral feeding (OR 3.85, 95% CI 1.23–12.02, p = 0.020), and coagulopathy (OD 12.64; 95% CI 1.13–141.13, p = 0.039) were associated with the higher rate of mortality. The rates of ECMO survival and survival to discharge were 70 and 50%, respectively.Conclusion: ECMO is the lifesaving tool for critically ill pediatric patients. Pre-existing acute kidney injury, delayed enteral feeding, and coagulopathy were the potential risk factors associated with poor outcomes in children receiving ECMO. However, ECMO setup can be done successfully in a developing country.

Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review

“…No randomized clinical trials were identified in this literature search. Studies did not always specify where the samples were obtained, but seven studies specified the PICU (2, 8, 13, 18, 19, 21, 22). Five studies were conducted in The Netherlands (12, 17, 19, 20, 24), four studies in the United States (9, 13, 18, 23), two studies in Spain (2, 21), one study in Singapore (8), one study in China (25), and one study in Thailand (22).…”

“…In the five studies that listed sex, both males and females were represented evenly (8, 9, 13, 17, 23, 24). Neonatal pulmonary and cardiac diseases were the greatest underlying diagnoses requiring ECMO (2, 8, 9, 12, 17–25). Four studies evaluated patients who only received EN (9, 12, 13, 20).…”

“…Four studies evaluated patients who only received EN (9, 12, 13, 20). Ten studies evaluated groups of patients who received EN along with those who received a combination of EN and PN (2, 8, 17–17, 21–25).…”

“…Underutilization referred to studies where there was delayed initiation of enteral feeds (> 48 hr post-ICU admission) or those that did not reach caloric goals. Many studies did not report the rate of those who reached full EN (2, 8, 9, 12, 13, 17, 22, 25). In the studies that presented adequate caloric goals, an average of 22% of patients achieved the caloric goals over a 1- to 5-day period (18–21, 23, 24).…”

“…Eight studies also indicated reduced mortality in those that received EN while on ECMO (2, 8, 9, 13, 22, 24, 25). It is important to note that patients who experienced malnutrition and who were underweight upon admission have a higher risk for further deterioration and mortality at baseline than those not admitted with these health concerns (7).…”