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Adrian Holloway, University of Maryland School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, Baltimore, USAFollow
Jason Custer, University of Maryland School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, Baltimore, USA
Ripal Patel, University of Maryland School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, Baltimore, USA
Peta Alexander, Harvard Medical School, Boston Children’s Hospital and Department of Pediatrics, Division of Pediatric Cardiology, Boston, USA
Peter Rycus, Extracorporeal Life Support Organization, Executive Director, Ann Arbor, USA
Cortney Foster, University of Maryland School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, Baltimore, USA
Dayanand Bagdure, University of Maryland School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, Baltimore, USA
Angelina June, Graduate Medical Education, Eastern Virginia Medical School, Norfolk USA
Vladimir Michtcherkin, University of Maryland School of Medicine, School of Epidemiology and Public Health, Baltimore, USA
William Blackwelder, University of Maryland School of Medicine, School of Epidemiology and Public Health, Baltimore, USA
Carissa Baker-Smith, Nemours Cardiac Center at Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA
Adnan Bhutta, University of Maryland School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, Baltimore, USA

Abstract

Objective: Extracorporeal Membrane Oxygenation (ECMO) support is increasingly used for refractory septic shock. There is lack of data on the outcomes of children requiring ECMO support for refractory septic shock. Our study objective was to describe the variables associated with survival, risk factors for mortality and outcomes of children requiring ECMO support for refractory shock. Materials and Methods: Retrospective registry study of 340 international centers contributing data to the ELSO Registry, analyzing children <18 years who received ECMO with septic shock, severe sepsis, sepsis, SIRS, toxic shock syndrome, shock associated with infection and septicemia from any organism from 1990 to 2015. Outcomes were analyzed by categorizing the data into survivors and non-survivors. Logistic regression models were used to describe the association of dependent variable and multiple independent variables. Results: A total of 1928 patients were identified which met the inclusion criteria. 744 (38.5%) of the cohort survived. Survivors in this cohort tend to have longer duration of ECMO (230 hrs vs 201 hrs, p =0.005) and shorter time from intubation to ECMO cannulation (87 hrs vs 116 hrs, p =0.0033) when compared to non-survivors. Survivors were also noted to have higher pH, higher serum bicarbonate, higher saturations, and higher systolic, diastolic, and mean arterial pressures compared to non-survivors. Conclusions: These results suggest that early initiation of ECMO therapy for refractory sepsis is associated with better patient outcomes. ECMO is unlikely to recover patients once circulatory and metabolic collapse has developed.

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