Extracorporeal Membrane Oxygenation and Hemolytic Uremic Syndrome in Children: Outcome Review of a Multicenter National Database

Abstract

Hemolytic uremic syndrome (HUS) is a triad of hemolytic anemia, thrombocytopenia, and acute renal failure. In critically ill children with HUS, extrarenal manifestations may require intensive care unit admission and extracorporeal membrane oxygenation (ECMO) support. Outcomes specific to HUS and ECMO in children have not been well investigated. The primary aim of this project was to query a multicenter database to identify risk factors associated with mortality in HUS patients supported on ECMO. A secondary aim was to identify factors associated with ECMO utilization in children with HUS. Utilizing the Pediatric Health Information System database (January 2004 and September 2018), this retrospective, multicenter cohort study identified the index HUS hospitalization among children aged 0 to 18 years. Univariate analysis was used to compare demographics, clinical characteristics, and procedures to identify risk factors associated with adverse outcomes. Among 4,144 subjects, 37 were supported on ECMO. Survival for those on ECMO support was 54%. Among nonsurvivors, 59% of deaths occurred within 14 days of hospitalization. The mean hospital LOS was 15.9 days in nonsurvivors versus 53.9 days for survivors (p < 0.001). When comparing subjects supported on ECMO to those who were not, patients with ECMO support had statistically longer hospital LOS and higher rates of extrarenal involvement (p < 0.001). This study found a mortality rate of 46% among HUS patients requiring ECMO. The investigated clinical risk factors were not associated with mortality among the ECMO population. The study identifies risk factors associated with ECMO utilization in children with HUS.

Venopulmonary ECMO Improved Hypoxemia and Supported the Right Ventricle in a Patient with Decompensated Eisenmenger Syndrome

“…Despite achieving respiratory and circulatory support goals, our patient died because of a complication associated with prolonged exposure to extracorporeal circulation. In this case, it was thrombotic microangiopathy, which, although rare, usually has a fatal outcome [20]. However, it is important to note that, despite the long period of extracorporeal support (34 days), the patient did not develop complications related to cannulation (infection, bleeding, thrombosis, dis- The advantages of VPA ECMO to limit complications include the possibility of being able to perform peripheral venous cannulation, with the lowest risk of bleeding and vascular complication, in addition to favoring the early mobilization and extubation of patients, limiting the risks of ventilator-associated pneumonia and myopathy of the critically ill patient secondary to the need for sedatives, analgesics and vasopressors for long periods of time.…”