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Critical Appraisal of Zabrocki et al: Survival and Predictors of Mortality. Crit Care Med 2011; 39:364–370

Musick, Matthew A. MD

Pediatric Critical Care Medicine: January 2013 - Volume 14 - Issue 1 - p 85–88
doi: 10.1097/PCC.0b013e3182604896
Evidence-Based Journal Club

Objective: To review the findings and discuss the implications of pediatric respiratory failure treated with extracorporeal membrane oxygenation.

Design: A critical appraisal of Extracorporeal membrane oxygenation for pediatric respiratory failure: Survival and predictors of mortality by Zabrocki et al (Crit Care Med 2011; 39:364370) and review of the relevant literature.

Findings: In this review of international data from 1993 to 2007, pediatric patients diagnosed with respiratory failure that met inclusion criteria and were treated with extracorporeal membrane oxygenation had an overall survival of 57%. This percentage did not change significantly over the study period; however, the number of patients with comorbidities did increase from 19% in 1993 to 47% in 2007. Survival varied significantly depending on diagnosis (83% for status asthmaticus vs. 23% for fungal pneumonia) and associated comorbidities (59% for chronic lung disease vs. 5% for hematopoietic stem cell transplantation). Clinical features associated with decreased survival included precannulation mechanical ventilation in excess of 14 days and venoarterial cannulation.

Conclusions: This study confirms that precannulation diagnoses and variables play a role in prognosis when pediatric patients with respiratory failure are treated with extracorporeal membrane oxygenation. Results of this investigation demonstrate that survival is improving in patients without comorbidities and that patients can be mechanically ventilated for up to 14 days prior to extracorporeal support initiation before mortality is increased.

Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Texas Childrens Hospital, Houston, TX.

The author has not disclosed any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies