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Extracorporeal Membrane Oxygenation for Severe Adenoviral Pneumonia in Neonatal, Pediatric, and Adult Patients

Ramanathan, Kollengode MD, FCICM, FCCP1; Tan, Chuen Seng PhD2; Rycus, Peter MPH3; MacLaren, Graeme MBBS, MSc, FCCM1,4

Pediatric Critical Care Medicine: November 2019 - Volume 20 - Issue 11 - p 1078-1084
doi: 10.1097/PCC.0000000000002047
Extracorporeal Support

Objectives: We examined data on patients with severe adenoviral pneumonia from the international registry of the Extracorporeal Life Support Organization to identify risk factors for mortality in patients receiving extracorporeal membrane oxygenation.

Design: Retrospective analysis.

Setting: International Registry of Extracorporeal Life Support Organization.

Patients: We collected de-identified data on all patients with adenoviral pneumonia who needed extracorporeal membrane oxygenation from 1992 to 2016 using International Classification of Diseases, 9th Edition, criteria.

Interventions: Our primary outcome measure was in-hospital mortality. We also collected data on demographics, preextracorporeal membrane oxygenation ventilator settings, biochemical variables, extracorporeal membrane oxygenation mode, duration, and complications. Initial bivariate analysis assessed potential associations between mortality and various preextracorporeal membrane oxygenation variables as well as extracorporeal membrane oxygenation factors. Variables with p values of less than 0.1 were considered for logistic regression analysis that identified predictors of mortality.

Measurements and Results: There were 542 patients with adenoviral pneumonia who were supported with extracorporeal membrane oxygenation. Overall mortality was 58% (307/529 patients) (neonates 86.4% [108/125 patients], children 49% [158/327 patients], and adults 49% [41/83 patients]). Multivariate regression identified hypercapnia (Pco2 > 45.7; odds ratio > 3.2; p < 0.001), immunosuppression (odds ratio, 4.44; 95% CI, 1.69–11.61; p = 0.002] and lack of pharmacologic paralysis (odds ratio, 0.30; 95% CI, 0.16–0.57; p < 0.001] as significant preextracorporeal membrane oxygenation factors for mortality. Neonatal patients had significantly higher mortality than pediatric or adult patients (odds ratio, 10.9; 95% CI, 3.2–37.3; p < 0.001). The presence of renal (odds ratio, 4.4; 95% CI, 2.5–7.7; p < 0.001), neurologic (odds ratio, 2.5; 95% CI, 1.2–5.1; p = 0.014), hemorrhagic (odds ratio, 2.2; 95% CI, 1.2–4.0; p = 0.014), or cardiovascular complications (odds ratio, 2.4; 95% CI, 1.3–4.6; p = 0.006) was associated with higher mortality on extracorporeal membrane oxygenation.

Conclusions: Patients with adenoviral pneumonia supported on extracorporeal membrane oxygenation had mortality of 58% over a 25-year-old period. We identified risk factors both before and during extracorporeal membrane oxygenation which were associated with higher mortality. Mortality in neonatal patients was particularly high.

1Cardiothoracic Intensive Care Unit, National University Heart Centre, Singapore.

2Swee Saw School of Public Health, National University of Singapore, Singapore.

3University of Michigan, Ann Arbor, MI.

4Paediatric Intensive Care Unit, Royal Children’s Hospital, University of Melbourne, Melbourne, VIC, Australia.

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The authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at Cardiothoracic ICU, National University Heart Centre, Singapore.

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Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies