Outcomes and associated ethical considerations of long-run pediatric ECMO at a single center institution

Guillermo J. Ares, Christie Buonpane, Irene Helenowski, Marleta Reynolds, Catherine Jane Hunter*

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Purpose: Survival of neonatal and pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) ≥ 21 days has not been well described. We hypothesized that patients would have poor survival and increased long-term complications. Methods: Retrospective, single center, review and case analysis. Tertiary-care university children’s hospital including neonatal, pediatric and cardiac intensive care units. After institutional review board approval, the charts of all patients < 18 years of age undergoing ECMO for ≥ 21 continuous days were performed, and they were compared to comparative patients undergoing shorter runs. Overall survival, incidence of complications, and post-discharge recovery were recorded. Results: Overall survival was 36% in patients undergoing ≥ 21 days of ECMO (N = 14). 5/8 patients with cardiopulmonary failure from acquired etiologies survived versus 0/6 patients with congenital anomalies. 1/5 survivors achieved complete recovery with no neurologic deficits. The remaining survivors suffer from multiple medical and neurodevelopmental morbidities. Conclusion: ECMO support for ≥ 21 days is associated with poor survival, particularly in neonates with congenital anomalies. Long-term outcomes for survivors ought to be carefully weighed and discussed with parents given the high incidence of neurologic morbidities in this population.

Original languageEnglish (US)
Pages (from-to)321-328
Number of pages8
JournalPediatric Surgery International
Volume35
Issue number3
DOIs
StatePublished - Mar 5 2019

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Keywords

  • Long-run
  • Moral distress, Ethics
  • Neonatal ECMO
  • Neurodevelopmental outcome
  • Pediatric ECMO

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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