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Long-Term Survival and Causes of Late Death in Children Treated With Extracorporeal Membrane Oxygenation*

von Bahr, Viktor MD; Hultman, Jan MD, PhD; Eksborg, Staffan PhD; Gerleman, Roxana MD; Enstad, Øyvind MD; Frenckner, Björn MD, PhD; Kalzén, Håkan MD

Pediatric Critical Care Medicine: March 2017 - Volume 18 - Issue 3 - p 272–280
doi: 10.1097/PCC.0000000000001069
Extracorporeal Support

Objective: Extracorporeal membrane oxygenation has been used in patients with severe circulatory or respiratory failure since the 1970s, but the knowledge on long-term survival in this group is scarce. The aim of the present study was to investigate the 10-year survival rates and causes of late death in children treated with extracorporeal membrane oxygenation.

Design: Single-center, retrospective cohort study.

Setting: Tertiary referral center for extracorporeal life support.

Patients: Neonatal and pediatric patients treated with extracorporeal membrane oxygenation from 1987 to December 2013.

Interventions: None.

Measurements and Main Results: Survival status was obtained from the national Causes of Death registry. Patient background data along with data on survival and causes of death were collected. Survival rates were calculated using the Kaplan-Meier method. Of 400 subjects, 76% survived to discharge. The median follow-up time in survivors was 7.2 years. There was a high mortality rate within the first months after discharge. In the group of patients who survived the first 90 days after treatment, the 10-year survival rates were 93% in neonates and 89% in pediatric patients and were particularly beneficial in patients whose indication for extracorporeal membrane oxygenation was meconium aspiration syndrome, trauma, or infectious diseases. Late deaths were seen in some diagnostic groups, but the Kaplan-Meier curves plateaued over time.

Conclusions: Children who survive the first months after treatment with extracorporeal membrane oxygenation have a high long-term survival rate. The prognosis is especially favorable in patients with reversible conditions.

1Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.

2ECMO Center Karolinska, ECMO Department, Karolinska University Hospital, Stockholm, Sweden.

3Childhood Cancer Research Unit Q6:05, Department of Women’s and Children’s Health, Karolinska Institutet and Astrid Lindgren Children’s Hospital, Stockholm, Sweden.

4Department of Anesthesiology and Intensive Care, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark.

5Department of Women’s and Children’s Health, Pediatric Surgery, Karolinska Institutet and Astrid Lindgren Children’s Hospital, Stockholm, Sweden.

*See also p. 287.

Drs. von Bahr, Kalzén, Frenckner, Gerleman, Enstad, and Hultman helped in conception and design. Drs. von Bahr, Kalzén, Eksborg, Frenckner, Gerleman, Enstad, and Hultman helped in analysis and interpretation. Drs. von Bahr, Kalzén, Eksborg , Frenckner, and Hultman helped in drafting the article for important intellectual content.

Work was performed at ECMO Center Karolinska.

Dr. von Bahr reports grants from Axel Tielman’s Memorial Fund, grants from Samariten foundation, and grants from Sällskapet Barnavård foundation, during the conduct of the study. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies