Tiffany Zens , Brian Lara , Brielle Ochoa , Richard S. Eldredge , Melinda Gregory , Mark S. Molitor
{"title":"Pediatric ECMO Outcomes in Children With Severe Infections: Does Infectious Source Matter?","authors":"Tiffany Zens , Brian Lara , Brielle Ochoa , Richard S. Eldredge , Melinda Gregory , Mark S. Molitor","doi":"10.1016/j.jpedsurg.2025.162170","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Although Extracorporeal Membrane Oxygenation (ECMO) utilization in pediatric patients with cardiopulmonary failure due to infection improves mortality, it is unclear whether the infectious etiology impacts outcomes. The aim of this study is to compare ECMO outcomes in children with sepsis and severe acute lung injury secondary to infections based on culture data.</div></div><div><h3>Methods</h3><div>A retrospective review was done of patients aged <18 with severe infections whose management included ECMO from 2013 to 2022 at a quaternary children's hospital. Respiratory and blood cultures were reviewed. Mortality for all groups was compared using univariate and multivariate models.</div></div><div><h3>Results</h3><div>A total of 155 patients were included. Overall mortality on ECMO was 36 % and mortality at discharge was 51 %. Using a Cox proportional hazards regression, patients with both positive blood and respiratory cultures at time of cannulation had an adjusted HR (Hazard Ratio) for mortality on ECMO of 7.65 (95 % CI 1.92–30.44, p = 0.004) and adjusted HR for mortality at discharge of 4.48 (95 % CI 1.69–11.88, p = 0.003) compared to those with only positive bacterial respiratory cultures. There was increased mortality on ECMO for patients with more than one virus identified on viral respiratory panel [HR 6.1 (CI 1.1–32.9, p = 0.03)], but no difference in mortality of patients with polymicrobial bacterial pneumonias. There was no relationship between bacterial organism and mortality, but patients with RSV and COVID viral infections demonstrated higher mortality.</div></div><div><h3>Conclusions</h3><div>ECMO outcomes in pediatric patients with cardiopulmonary failure secondary to infection differ based on the infectious source. This information is important when discussing prognosis with families prior to cannulation.</div></div><div><h3>Study Type/Level of Evidence</h3><div>Retrospective Review, Cohort study.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162170"},"PeriodicalIF":2.5000,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pediatric surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022346825000156","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Although Extracorporeal Membrane Oxygenation (ECMO) utilization in pediatric patients with cardiopulmonary failure due to infection improves mortality, it is unclear whether the infectious etiology impacts outcomes. The aim of this study is to compare ECMO outcomes in children with sepsis and severe acute lung injury secondary to infections based on culture data.
Methods
A retrospective review was done of patients aged <18 with severe infections whose management included ECMO from 2013 to 2022 at a quaternary children's hospital. Respiratory and blood cultures were reviewed. Mortality for all groups was compared using univariate and multivariate models.
Results
A total of 155 patients were included. Overall mortality on ECMO was 36 % and mortality at discharge was 51 %. Using a Cox proportional hazards regression, patients with both positive blood and respiratory cultures at time of cannulation had an adjusted HR (Hazard Ratio) for mortality on ECMO of 7.65 (95 % CI 1.92–30.44, p = 0.004) and adjusted HR for mortality at discharge of 4.48 (95 % CI 1.69–11.88, p = 0.003) compared to those with only positive bacterial respiratory cultures. There was increased mortality on ECMO for patients with more than one virus identified on viral respiratory panel [HR 6.1 (CI 1.1–32.9, p = 0.03)], but no difference in mortality of patients with polymicrobial bacterial pneumonias. There was no relationship between bacterial organism and mortality, but patients with RSV and COVID viral infections demonstrated higher mortality.
Conclusions
ECMO outcomes in pediatric patients with cardiopulmonary failure secondary to infection differ based on the infectious source. This information is important when discussing prognosis with families prior to cannulation.
背景：虽然体外膜氧合（ECMO）应用于感染导致心肺衰竭的儿科患者可提高死亡率，但尚不清楚感染病因是否影响预后。本研究的目的是比较基于培养数据的脓毒症和继发于感染的严重急性肺损伤儿童的ECMO结果。方法：对老年患者进行回顾性分析。结果：共纳入155例患者。ECMO的总死亡率为36%，出院时死亡率为51%。使用Cox比例风险回归，插管时血液和呼吸培养均阳性的患者与仅细菌呼吸培养阳性的患者相比，ECMO死亡率的调整HR（风险比）为7.65 (95% CI 1.92-30.44, p = 0.004)，出院时死亡率的调整HR为4.48 （95% CI 1.69-11.88, p = 0.003）。在病毒呼吸面板上发现一种以上病毒的患者，ECMO的死亡率增加[HR 6.1 (CI 1.1-32.9, p = 0.03)]，但多微生物细菌性肺炎患者的死亡率没有差异。细菌有机体与死亡率之间没有关系，但RSV和COVID病毒感染患者的死亡率更高。结论：感染继发性心肺衰竭患儿的ECMO结果因感染源的不同而不同。在插管前与家人讨论预后时，这一信息很重要。研究类型/证据水平：回顾性研究，队列研究。
期刊介绍：
The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
