Advertisement

Pediatric Surgery International

, Volume 35, Issue 3, pp 321–328 | Cite as

Outcomes and associated ethical considerations of long-run pediatric ECMO at a single center institution

  • Guillermo J. Ares
  • Christie Buonpane
  • Irene Helenowski
  • Marleta Reynolds
  • Catherine J. HunterEmail author
Original Article
  • 58 Downloads

Abstract

Purpose

Survival of neonatal and pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) ≥ 21 days has not been well described. We hypothesized that patients would have poor survival and increased long-term complications.

Methods

Retrospective, single center, review and case analysis. Tertiary-care university children’s hospital including neonatal, pediatric and cardiac intensive care units. After institutional review board approval, the charts of all patients < 18 years of age undergoing ECMO for ≥ 21 continuous days were performed, and they were compared to comparative patients undergoing shorter runs. Overall survival, incidence of complications, and post-discharge recovery were recorded.

Results

Overall survival was 36% in patients undergoing ≥ 21 days of ECMO (N = 14). 5/8 patients with cardiopulmonary failure from acquired etiologies survived versus 0/6 patients with congenital anomalies. 1/5 survivors achieved complete recovery with no neurologic deficits. The remaining survivors suffer from multiple medical and neurodevelopmental morbidities.

Conclusion

ECMO support for ≥ 21 days is associated with poor survival, particularly in neonates with congenital anomalies. Long-term outcomes for survivors ought to be carefully weighed and discussed with parents given the high incidence of neurologic morbidities in this population.

Keywords

Neonatal ECMO Pediatric ECMO Long-run Neurodevelopmental outcome Moral distress, Ethics 

Notes

Acknowledgements

This project was presented at The MacLean Center for Clinical Medical Ethics April 2018 and at the Academic Surgical Congress 2018.

Funding

This study was funded by the National Institutes of Health NIDDK K08DK106450 (CH) but did not receive any specific grant from funding agencies in the commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

References

  1. 1.
    Andrews AF, Klein MD, Toomasian JM, Roloff DW et al (1983) Venovenous extracorporeal membrane oxygenation in neonates with respiratory failure. J Pediatr Surg 18(4):339–346CrossRefGoogle Scholar
  2. 2.
    Glass P, Miller MShort B (1989) Morbidity for survivors of extracorporeal membrane oxygenation: neurodevelopmental outcome at 1 year of age. Pediatrics 83(1):72–78Google Scholar
  3. 3.
    Grover TR, Rintoul NEHedrick HL (2018) Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia. Semin Perinatol 42(2):96–103CrossRefGoogle Scholar
  4. 4.
    Prodhan P, Stroud M, El-Hassan N, Peeples S et al (2014) Prolonged extracorporeal membrane oxygenator support among neonates with acute respiratory failure: a review of the Extracorporeal Life Support Organization registry. ASAIO J 60(1):63–69CrossRefGoogle Scholar
  5. 5.
    Green TP, Moler FWGoodman DM (1995) Probability of survival after prolonged extracorporeal membrane oxygenation in pediatric patients with acute respiratory failure. Extracorporeal Life Support Organization Crit Care Med 23(6):1132–1139Google Scholar
  6. 6.
    Brogan TV, Zabrocki L, Thiagarajan RR, Rycus PT et al (2012) Prolonged extracorporeal membrane oxygenation for children with respiratory failure. Pediatr Crit Care Med 13(4):e249–e254CrossRefGoogle Scholar
  7. 7.
    Kays DW, Islam S, Richards DS, Larson SD et al (2014) Extracorporeal life support in patients with congenital diaphragmatic hernia: how long should we treat? J Am Coll Surg 218(4):808–817CrossRefGoogle Scholar
  8. 8.
    Merrill ED, Schoeneberg L, Sandesara P, Molitor-Kirsch E et al (2014) Outcomes after prolonged extracorporeal membrane oxygenation support in children with cardiac disease—Extracorporeal Life Support Organization registry study. J Thorac Cardiovasc Surg 148(2):582–588CrossRefGoogle Scholar
  9. 9.
    Partridge EA, Peranteau WH, Rintoul NE, Herkert LM et al (2015) Timing of repair of congenital diaphragmatic hernia in patients supported by extracorporeal membrane oxygenation (ECMO). J Pediatr Surg 50(2):260–262CrossRefGoogle Scholar
  10. 10.
    Bein T, Weber-Carstens SHerridge M (2015) Extracorporeal life support, ethics, and questions at the bedside: how does the end of the pathway look? Intensive Care Med 41(9):1714–1715CrossRefGoogle Scholar
  11. 11.
    Abdulhai S, Glenn IC, McNinch NL, Ponsky TA et al (2018) Current practices in the management of congenital diaphragmatic hernia patients requiring extracorporeal membrane oxygenation: results of an International Survey of Pediatric Surgeons. J Laparoendosc Adv Surg Tech A 28(5):606–609CrossRefGoogle Scholar
  12. 12.
    Mahmood B, Newton DPallotto EK (2018) Current trends in neonatal ECMO. Semin Perinatol 42(2):80–88CrossRefGoogle Scholar
  13. 13.
    Gulack BC, Hirji SAHartwig MG (2014) Bridge to lung transplantation and rescue post-transplant: the expanding role of extracorporeal membrane oxygenation. J Thorac Dis 6(8):1070–1079Google Scholar
  14. 14.
    Wallinder A, Pellegrino V, Fraser JFMcGiffin DC (2017) ECMO as a bridge to non-transplant cardiac surgery. J Card Surg 32(8):514–521CrossRefGoogle Scholar
  15. 15.
    Kukora SLaventhal N (2016) Choosing wisely: should past medical decisions impact the allocation of scarce ECMO resources? Acta Paediatr 105(8):876–878CrossRefGoogle Scholar
  16. 16.
    Beauchamp TL (2011) Informed consent: its history, meaning, and present challenges. Camb Q Healthc Ethics 20(4):515–523CrossRefGoogle Scholar
  17. 17.
    Brach C (2016) Even in an emergency, doctors must make informed consent an informed choice. Health Aff (Millwood) 35(4):739–743CrossRefGoogle Scholar
  18. 18.
    Boisaubin EVDresser R (1987) Informed consent in emergency care: illusion and reform. Ann Emerg Med 16(1):62–67CrossRefGoogle Scholar
  19. 19.
    McCarthy DM, Leone KA, Salzman DH, Vozenilek JA et al (2012) Language use in the informed consent discussion for emergency procedures. Teach Learn Med 24(4):315–320CrossRefGoogle Scholar
  20. 20.
    Doorenbos AZ, Starks H, Bourget E, McMullan DM et al (2013) Examining palliative care team involvement in automatic consultations for children on extracorporeal life support in the pediatric intensive care unit. J Palliat Med 16(5):492–495CrossRefGoogle Scholar
  21. 21.
    Kon AA, Shepard EK, Sederstrom NO, Swoboda SM et al (2016) Defining futile and potentially inappropriate interventions: a policy statement from The Society of Critical Care Medicine Ethics Committee. Crit Care Med 44(9):1769–1774CrossRefGoogle Scholar
  22. 22.
    Campbell SM, Ulrich CMGrady C (2016) A broader understanding of moral distress. Am J Bioeth 16(12):2–9CrossRefGoogle Scholar
  23. 23.
    Cortina G, Niederwanger C, Klingkowski U, Velik-Salchner C et al (2018) Prolonged extracorporeal membrane oxygenation for pediatric necrotizing pneumonia due to Streptococcus pneumonia and influenza H1N1 co-infection: how long should we wait for native lung recovery? J Artif OrgansGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pediatric SurgeryAnn and Robert H. Lurie Children’s Hospital of ChicagoChicagoUSA
  2. 2.Department of SurgeryUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Feinberg School of MedicineNorthwestern UniversityChicagoUSA

Personalised recommendations