Brenna McCabe, MD
PCCM Fellow
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Adam Himebauch, MD
Assistant Professor of Anesthesiology and Critical Care Medicine
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Wynne Morrison, MD, MBE,FCCM
Director of the Justin Michael Ingerman Center for Palliative Care
Childrens Hospital of Philadelphia
Cherry Hill, New Jersey, United States
Disclosure information not submitted.
Title: Patient Factors Associated with Perception of ECMO Candidacy for Pediatric Acute Respiratory Failure
Introduction/Hypothesis: Patient factors associated with the decision of clinicians to offer extracorporeal membrane oxygenation (ECMO) for pediatric patients with severe acute respiratory failure (ARF) are unknown. We hypothesized that neurologic comorbidities and functional status would be the most important considerations when pediatric intensivists determine ECMO candidacy.
Methods: This study is a prospective survey of pediatric intensivists caring for patients admitted to an academic Pediatric Intensive Care Unit with ARF from shock or respiratory disease. Intensivists were asked within 72 hours of initiation or escalation of invasive mechanical ventilation whether they would offer ECMO should their patient deteriorate and what factors influenced their decision. Patient data were abstracted from the medical record. Survey responses were summarized as number and percentage with comparisons made with Fisher’s exact test.
Results: Survey responses were received for 77 of 112 patients (69% response rate), from 26 intensivists. Respiratory infection and sepsis were the most common causes of ARF. 20 patients (26%) were not considered ECMO candidates. There were no differences by patient gender (p=0.6), race (p=0.9), ethnicity (p=0.7), or type of artificial airway (p=0.17). Patients > 6 years old were more likely to be considered non-candidates (38% vs 16%, p=0.03). The most frequent reasons cited for non-candidacy were poor prognosis of a chronic or genetic condition (85%), abnormal baseline functional status (55%), and pre-existing comorbidities (50%). Patient factors associated with non-candidacy were chronic respiratory failure (p=0.036) and several neurologic comorbidities (p=0.04) while prematurity (p=0.8), genetic disorder (p=0.8), cancer (p=1), stem cell transplant (p=0.6), and sepsis (p=0.05) were not.
Conclusions: Pediatric intensivists reported prognosis of a chronic or genetic condition, functional status, and comorbidities as the most important factors when determining ECMO candidacy. Patients with chronic respiratory failure or neurologic comorbidity were less likely to be seen as candidates. Factors historically viewed as contraindications such as cancer, stem cell transplant, and sepsis were not associated with opinions on candidacy.