Factors associated with mortality in pediatric patients requiring extracorporeal life support for severe pneumonia

OBJECTIVES:: In children with respiratory failure secondary to pneumonia, extracorporeal life support can be lifesaving. Our goal was to identify variables associated with mortality in children with pneumonia requiring extracorporeal life support. DESIGN:: Data query and abstraction from a multicenter, international registry of extracorporeal life support, the Extracorporeal Life Support Organization Registry. SETTING:: Extracorporeal Life Support Organization registry data from 1985 to 2010. PATIENTS:: Patients ≤ 18 yr of age who received extracorporeal life support for respiratory failure secondary to pneumonia. INTERVENTIONS:: None. MEASUREMENTS AND OUTCOMES:: Clinical variables, year of extracorporeal life support, and extracorporeal life support center location were collected. The primary outcome was survival at hospital discharge. Results are reported as predictive margins, which allow estimation of standardized mortality rates and differences for risk factors. RESULTS:: One thousand four hundred eighty-nine children were included. The median (interquartile range) age and duration of extracorporeal life support were 5.7 months (2.5-21.5) and 11 days (7-18). Arterial cannulation was performed in 65% of patients. Mortality was 39%. There was no relationship between mortality and age or pathogen. Duration of extracorporeal life support had a biphasic relationship on mortality; mortality decreased 1.3% per day on extracorporeal life support until 14 days and then increased by 1.8% per day thereafter. Other independent predictors of mortality (p < 0.05) were pre-extracorporeal life support factors including duration of mechanical ventilation, peak inspiratory pressure, arterial oxygen saturation, pH, cardiac arrest, need for an arterial cannula, decade of extracorporeal life support, international extracorporeal life support center, and decrease in FIO2 over the first 24 hrs on extracorporeal life support. CONCLUSIONS:: In children with severe pneumonia receiving extracorporeal life support, prognostic factors associated with increased risk of death included extracorporeal life support treatment exceeding 14 days, arterial cannulation, longer duration of mechanical ventilation, and decreased ability to wean ventilator FIO2 over the first 24 hrs on extracorporeal life support. Analysis of the Extracorporeal Life Support Organization registry can identify prognostic variables, which may influence medical decision making, resource utilization, and family counseling.