The Use of Extracorporeal Life Support in Children With Immune-Mediated Diseases. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Barreto, Jessica A.; Mehta, Amit; Thiagarajan, Ravi R.; Hayward, Kristen N.; Brogan, Adrian; Brogan, Thomas V.
• Is Part Of: Pediatric critical care medicine. Volume 23:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: adolescent -- child -- complex chronic conditions -- Extracorporeal Life Support Organization -- extracorporeal membrane oxygenation -- immune system diseases; Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000002801
• Languages: English
• ISSNs: 1529-7535

Abstract

Abstract : OBJECTIVES: To describe the use and outcomes of extracorporeal membrane oxygenation support among children with immune-mediated conditions. DESIGN: Retrospective cohort study. SETTING: The Extracorporeal Life Support Organization registry. PATIENTS: Patients 1 month to 18 years old with International Classification of Diseases, 9th Edition and International Classification of Diseases, 10th Edition codes for immune-mediated conditions from 1989 to 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During the study period, 207 patients with an immune-mediated condition received extracorporeal membrane oxygenation, and 50% survived to discharge. Most patients (63%) received extracorporeal membrane oxygenation for respiratory support with 53% survival, 21% received cardiac support (55% survival), and 15% received extracorporeal cardiopulmonary resuscitation (34% survival). The most common diagnosis among nonsurvivors was hemophagocytic lymphohistiocytosis/macrophage activation syndrome with 37% survival. Patients with juvenile idiopathic arthritis (23%) and dermatomyositis (25%) had the lowest survival. Nonsurvivors had a higher frequency of infections, neurologic complications, and renal replacement therapy use. Use of preextracorporeal membrane oxygenation corticosteroids was associated with mortality. CONCLUSIONS: Children with immune-mediated conditions can be successfully supported with extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation use has increased over time, and survival varies considerably by diagnosis. Abstract : Supplemental Digital Content is available in the text.