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Tracheostomy and long‐term mechanical ventilation in children after veno‐venous extracorporeal membrane oxygenation
Author(s) -
Mallory Palen P.,
Barbaro Ryan P.,
Bembea Melania M.,
Bridges Brian C.,
Chima Ranjit S.,
Kilbaugh Todd J.,
Potera Renee M.,
Rosner Elizabeth A.,
Sandhu Hitesh S.,
Slaven James E.,
Tarquinio Keiko M.,
Cheifetz Ira M.,
Friedman Matthew L.
Publication year - 2021
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25546
Subject(s) - medicine , extracorporeal membrane oxygenation , mechanical ventilation , ventilation (architecture) , incidence (geometry) , retrospective cohort study , respiratory failure , cohort , cohort study , intensive care medicine , anesthesia , surgery , mechanical engineering , physics , optics , engineering
Objective Our objective is to characterize the incidence of tracheostomy placement and of new requirement for long‐term mechanical ventilation after extracorporeal membrane oxygenation (ECMO) among children with acute respiratory failure. We examine whether an association exists between demographics, pre‐ECMO and ECMO clinical factors, and the placement of a tracheostomy or need for long‐term mechanical ventilation. Methods A retrospective multicenter cohort study was conducted at 10 quaternary care pediatric academic centers, including children supported with veno‐venous (V‐V) ECMO from 2011 to 2016. Results Among 202 patients, 136 (67%) survived to ICU discharge. All tracheostomies were placed after ECMO decannulation, in 22 patients, with 19 of those surviving to ICU discharge (14% of survivors). Twelve patients (9% of survivors) were discharged on long‐term mechanical ventilation. Tracheostomy placement and discharge on home ventilation were not associated with pre‐ECMO severity of illness or pre‐existing chronic illness. Patients who received a tracheostomy were older and weighed more than patients who did not receive a tracheostomy, although this association did not exist among patients discharged on home ventilation. ECMO duration was longer in those who received a tracheostomy compared with those who did not, as well as for those discharged on home ventilation, compared to those who were not. Conclusion The 14% rate for tracheostomy placement and 9% rate for discharge on long‐term mechanical ventilation after V‐V ECMO are important patient‐centered findings. This study informs anticipatory guidance provided to families of patients requiring prolonged respiratory ECMO support, and lays the foundation for future research.