Extracorporeal membrane oxygenation for immunocompromised children with acute respiratory distress syndrome: a French referral center cohort

Abstract

Background: Immunocompromised children are likely to develop a refractory acute respiratory distress syndrome (ARDS). The usefulness of providing extracorporeal life support (ECLS) to these patients is a subject of debate. The aim of our study was to report the outcomes and to compare factors associated with mortality between immunocompromised and non-immunocompromised children supported with veno-venous ECMO. Methods:We performed a retrospective monocentric study in the French pediatric ECMO center of Armand Trousseau Hospital, including all pediatric patients aged from 1 month to 18 years requiring ECLS for ARDS.Results: Between 2007 and 2018, one hundred and eleven (111) patients underwent ECMO for respiratory failure; among them twenty-five (25) were immunocompromised. Survival rate at 6 months after intensive care discharge was significantly lower for immunocompromised patients compared to non-immunocompromised ones (41.7% vs. 62.8%; p = 0.04). ARDS severity was similar between the 2 groups. Fungal pneumonias were reported only in immunocompromised patients (12.5% versus 0% in the control group; p = 0.001). Bleeding complications were significantly more frequent in the immunocompromised group and blood product transfusions were also more frequently required in this group. Conclusion:Six months after intensive care discharge, survival rate of immunocompromised children supported with ECMO for pediatric ARDS is lower than for nonimmunocompromised patients. But, the expectation for a favorable outcome is real and it is worth it if their condition is likely to be compatible with a good long-term quality of life.

Extracorporeal Membrane Oxygenation in Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference

“…As an example, children suffering from malignancies (solid tumor, leukemia, or hematopoietic cell transplantation [HCT]) are a specific population for whom the decision to use ECMO remain challenging. Recent observational study reported wide survival rate mainly depending on the underlying disease (13, 33). To help physician to evaluate the potential benefit of ECMO in immunocompromised patients, Di Nardo et al (34) published experts recommendation on ECMO used in HCT and Zinter et al (35) proposed a decision-making graph to better define potential candidate for ECMO in the HCT children population.…”

“…T he 2015 Pediatric Acute Lung Injury Consensus Conference (PALICC) international recommendations on pediatric acute respiratory distress syndrome (PARDS) published 11 recommendations regarding the role of extracorporeal membrane oxygenation (ECMO) support in PARDS (1). Since 2015, there have been advances in ECMO research in adults with acute respiratory distress syndrome (ARDS) (2)(3)(4)(5)(6), devices and cannulas (7), management (8)(9)(10), and expanding indications, most notably COVID-19 (11)(12)(13).…”

Long-Term Outcomes of Extracorporeal Life Support in Respiratory Failure

“…Immunocompromised and non-immunocompromised children up to 18 years old with ARDS were evaluated in a French study with 111 participants [ 37 ]. The survival rate at 6 months after the intensive care discharge was significantly lower in immunocompromised patients compared to non-immunocompromised ones (41.7% vs. 62.8%; p = 0.04).…”