Patient selection: pediatric patient on ECMO
Outcome: mortality
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Volume of ECMO Use
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Descriptor
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< 20 per year
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low
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20 to 49
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medium
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>= 50
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large
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Risk factors for mortality in a neonate:
(1) mild prematurity (35 to 36 weeks gestational age)
(2) acute renal failure
(3) intraventricular hemorrhage
(4) receipt of dialysis
(5) center with low volume of ECMO use
(6) primary pulmonary disease (sepsis, congenital diaphragmatic hernia, severe heart disease, asphyxia at birth, surgical care, other) vs primary pulmonary hypertension
Risk factors associated with lower mortality in a neonate:
(1) primary pulmonary disease meconium aspiration
(2) center with high volume of ECMO use
Risk factors for mortality in an infant or child:
(1) acute renal failure
(2) acute liver necrosis
(3) ECMO started > 14 days into hospital stay
(4) primary pulmonary disease (aspiration, viral or bacterial pneumonia, sepsis, acute respiratory failure, pulmonary embolism, cystic fibrosis, lung transplant) versus asthma
Risk factors associated with lower mortality in an infant or older child:
(1) acute pancreatitis
(2) receipt of bronchoscopy
Recommendations:
(1) start ECMO earlier (do not delay)
(2) try to preserve organ function
