Risk Factors of Kirkland et al for Mortality in Pediatric Patients Receiving Extracorporeal Membrane Oxygenation (ECMO) for Respiratory Failure

Patient selection: pediatric patient on ECMO

Outcome: mortality

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