To evaluate the relationship between duration of mechanical ventilation
before the initiation of extracorporeal life support
and the survival rate in children with respiratory failure
. Extracorporeal life support
has been used as a rescue therapy for >30 yrs in children with severe respiratory failure
. Previous studies suggest patients who received >7–10 days of mechanical ventilation
were not acceptable extracorporeal life support
candidates as a result of irreversible lung damage.
A retrospective review encompassing the past 10 yrs of the International Extracorporeal Life Support Organization Registry
(January 1, 1999, to December 31, 2008).
Setting: Extracorporeal Life Support Organization Registry
A total of 1325 children (≥ 30 days and ≤ 18 yrs) met inclusion criteria.
Measurements and Main Results:
The following pre-extracorporeal life support
variables were identified as independently and significantly related to the chance of survival: 1) >14 days of ventilation vs. 0–7 days was adverse (odds ratio, 0.32; p
< .001); 2) the presence of a cardiac arrest was adverse (odds ratio, 0.56; p
= .001); 3) pH per 0.1-unit increase was protective (odds ratio, 1.15; p
< .001); 4) oxygenation index, per 10-unit increase was adverse (odds ratio, 0.95; p
= .002); and 5) any diagnosis other than sepsis was related to a more favorable outcome. Patients requiring >7–10 or >10–14 days of pre-extracorporeal life support
ventilation did not have a statistically significant decrease in survival as compared with patients who received 0–7 days.
There was a clear relationship between the number of mechanical ventilation
days before the initiation of extracorporeal life support
and survival. However; there was no statistically significant decrease in survival until >14 days of pre-extracorporeal life support
ventilation was reached regardless of underlying diagnosis. We found no evidence to suggest that prolonged mechanical ventilation
should be considered as a contraindication to extracorporeal life support
in children with respiratory failure
before 14 days.