Cydney Opolka, BS
Clinical Research Coordinator
Children's Healthcare of Atlanta, United States
Disclosure information not submitted.
Carrie Mason, BA, BS, RRT
Pediatric Clinical Research Professional
Children's Healthcare of Atlanta, United States
Disclosure information not submitted.
Anne Fitzpatrick, PhD, CPNP
Professor
Emory University School of Medicine, United States
Disclosure information not submitted.
Jocelyn Grunwell, MD, PhD
Assistant Professor
Emory University/Children's Healthcare of Atlanta Egleston
Atlanta, Georgia, United States
Disclosure information not submitted.
Title: Outcomes After Isoflurane and Extracorporeal Life Support Use in Children with Near-Fatal Asthma
Introduction: Isoflurane (ISO) and extracorporeal life support (ECLS) are used in children intubated for near-fatal status asthmaticus when conventional therapies fail. There is limited information on the characteristics and outcomes of these children. Our objective is to characterize the baseline features, clinical course, and functional outcomes of a cohort of children with near-fatal asthma who received ISO and/or ECLS.
Methods: This is a single-center, retrospective cohort study of children under age 18 from 5/2009 – 12/2020 treated with ISO and/or ECLS for status asthmaticus. Data was collected from the electronic medical record. Primary outcome was decrease in p<sub>aCO2 after ISO initiation. Secondary outcome was need for inpatient rehab and change in functional status score (FSS). Repeated measures one-way ANOVA with p-values adjusted using the Bonferroni multiple testing correction method were used to analyze the ventilatory response after initiation of ISO and the FSS from baseline to PICU and rehab discharge.
Results: Fifty-seven children (median age 7.8 years, 63% male) were analyzed. The majority were non-Hispanic (91%), African American (72%) children with no comorbidities (63%). Nearly all had a prior diagnosis of asthma (89%) and 52% had a prior PICU admission. ISO was used in 48/57 (84%) of children and in 7/16 (44%) of children who required ECLS. Hypercarbia improved within 1h of ISO initiation (p < 0.0001). Four children (7%) died, and 18/53 (34%) survivors were discharged to inpatient rehab. Of this group, 14 (26.4%) had a change in FSS of 3+ from baseline to PICU discharge and primarily in the feeding domain (p < 0.0001). There were 24/53 (45%) children with at least one asthma exacerbation in the year following PICU admission. Moderate deficits in percent predicted FEV1 and in the FEV1/FVC ratio occurred in 25/53 (47%) of the children with follow-up pulmonary function tests.
Conclusions: The use of ISO in the setting of near-fatal asthma improves ventilation within one to four hours of initiation. Functional deficits occur in the feeding domain from baseline to PICU discharge that improve but persist despite inpatient rehabilitation. Pulmonary function deficits are present and nearly half of the children in this high-risk cohort have at least one asthma exacerbation within a year of PICU discharge.