Clinical observation of venous-arterial extracorporeal membrane oxygenation in the treatment of refractory septic shock in children

Objective To investigate the efficacy of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in the treatment of refractory septic shock in children. Methods From January 2016 to December 2018, the clinical data of children with refractory septic shock (RSS) treated by VA-ECMO in Department of Critical Medicine Affiliated Children's Hospital of Shanghai Jiao Tong University were retrospectively analyzed. The patients with refractory septic shock (RSS) treated by VA-ECMO were compared with those with non-refractory septic shock (NRSS). Results There were 8 cases in the RSS-ECMO group and 6 cases in the NRSS-ECMO group. The sex, age, PRISM score, complication showed no significant difference in the two groups. The median time of ECMO in the RSS-ECMO group was 182 (141, 216) h , and 5 patients were survived and were discharged from the hospital. The blood lactic acid and vasoactive drug index in the RSS-ECMO group was significantly higher than that in the NRSS-ECMO group (P 0.05). After ECMO establishment, the mean invasive arterial pressure increased significantly at 6 h, and lactic acid decreased significantly at 12 h after ECMO support. SCVO2 returned to normal at 24-h ECMO therapy. Conclusions The success rate of VA-ECMO treatment in children with refractory septic shock complicated with MODS is similar to that of children with non-refractory septic shock. The relationship between ECMO and hemodynamic indexes in sepsis should be further explored. Key words: Venoarterial extracorporeal membrane oxygenation (VA-ECMO); Continuous renal replacement therapy (CRRT); Sepsis; Refractory septic shock; Mortality; Child