TOP 78 - Pulmonary Sequelae after Pediatric Extracorporeal Membrane Oxygenation

Publication Number: 1836.TOP 78

Amaryllis Fernandes, Baylor College of Medicine, Houston, TX, United States; Andrea Ontaneda Perez, Baylor College of Medicine, Houston, TX, United States

Background: As extracorporeal membrane oxygenation (ECMO) use in the Pediatric Intensive Care Unit (PICU) has increased, there has been an increase in not only the number of survivors but also the number of patients who have new morbidities and long-term complications. Some of the long term impacts of ECMO that have been recognized are lung injury, deconditioning and an overall decrease in functional status, often leading to a decreased quality of life and increased risk of hospital readmission. Strategies such as tracheostomy or extubation while on ECMO have been used to try and address these long-term impacts. These strategies offer theoretical benefits such as opportunities for lung protection, decreased sedation and increased mobility; however, this practice is much less common in pediatrics when compared to adult ICU care. While there has been a recent increase in rates of extubation and tracheostomies for children while on ECMO, there is still quite limited data on these patients and their pulmonary outcomes

Objective: We will describe the pulmonary sequelae on pediatric patients undergoing ECMO for respiratory causes and evaluate the incidence of tracheostomy placement while on or peri-ECMO, the indication for placement and the impact on patient outcomes. We will also examine the various modes of respiratory support required at hospital discharge, including non-invasive positive pressure ventilation (NIPPV) modes such as continuous positive airway pressure and bilevel positive airway pressure, and oxygen dependence

Design/Methods: This study is a retrospective single center cohort study using data from Texas Children’s Hospital (TCH) patient database as well as data collected by Extracorporeal Life Support Organization (ELSO). Demographic, clinical, and outcome data were extracted from the TCH and ELSO ECMO databases. Demographic data included sex, age, and race/ethnicity. Clinical characteristics included ventilatory support modality, NIPPV, oxygen dependence, indication for ECMO, ECMO support type, number of hours on ECMO, timing of ECMO run, and timing of tracheostomy. Outcome measures included patient survival, time to decannulation, time to hospital discharge, and respiratory support requirements after ECMO (oxygen dependence, new mechanical ventilation need, trach dependence). Association of demographic or clinical features with the categorical outcomes will be analyzed using chi-square or Fisher’s exact test as statistically appropriate. Association of patient characteristics with post-ECMO length of stay as a continuous variable will be performed using the Mann-Whitney U test