Extracorporeal life support for severe pediatric respiratory failure: An updated experience 1991–1993

The purpose of this study was to examine our recent experience with children who had acute respiratory failure managed with extracorporeal life support (ECLS) from 1991 to 1993, to determine whether a change in survival rate had occurred in comparison with our previous experience. Design: Historic and prospective cohort study. Setting: A tertiary pediatric referral center. Patients: All nonneonatal pediatric patients treated with ECLS for severe, life-threatening respiratory failure were examined. Overall, 25 patients have been managed with this life-support technique in the past 28 months. Eighty-four percent (21/25) were transferred to our medical center because of failure of conventional mechanical ventilation therapy. Descriptive data of the recent cohort were as follows (mean ± SD): age 60±75 months, weight 23.6±24.8 kg, and male gender 44%. Duration of intubation before ECLS was 5.8±2.7 days. Arterial blood gas values and ventilator settings immediately before ECLS were as follows: fraction of inspired oxygen, 0.98±0.08; mean airway pressure, 21.6±6.2 cm H 2O; peak inspiratory pressure, 45.5±9.6 cm H 2O; positive endexpiratory pressure, 11.0±4.3 cm H 2O; partial pressure of oxygen (arterial), 56±20 mm Hg (7.4±2.7 kilopascals); partial pressure of carbon dioxide (arterial), 46±17 mm Hg (6.1±2.3 kPa); and estimated alveolar-arterial oxygen tension difference, 572±81 mm Hg (76.3±10.8 kPa). Mean duration of ECLS was 373±259 hours. Of 25 recently treated patients, 22 (88%) survived their lifethreatening respiratory illness to be discharged home; this represented a statistically improved survival rate in comparison with the 58% survival rate previously reported by us for similar patients ( p