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Abstract

Objective: Hemolytic uremic syndrome (HUS) is a triad of hemolytic anemia, thrombocytopenia, and acute renal failure. In critically ill children with HUS, extra-renal 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. Methods: Utilizing the Pediatric Health Information System (PHIS®) database (January 2004 and September 2018), this retrospective, multicenter cohort study identified the index HUS hospitalization among children aged 0-18 years. Univariate analysis was used to compare demographics, clinical characteristics, and procedures to identify risk factors associated with adverse outcomes. Results: Among 4,144 subjects, 37 were supported on ECMO. Survival for those on ECMO support was 54%. Among non-survivors, 59% of deaths occurred within 14 days of hospitalization. The mean hospital LOS was 15.9 days in non-survivors vs 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 length of stay (LOS) and higher rates of extra-renal involvement (p<0.001). Conclusion: This study found a mortality rate of 46% among HUS patients requiring ECMO. The investigated clinical risk factors were not associated with mortality amongst the ECMO population. The study identifies risk factors associated with ECMO utilization in children with HUS.

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