1. Great Ormond Street Hospital for Children, London
Pediatricke ECMO
(pro koho, kdy a jak)
Ann Karimova
Great Ormond Street Hospital for Children, London

2. pediatricke ECMO - pro koho, kdy a jak respiracni (MAS, CDH, PPHN)
Novorozenecke
ECMO
respiracni (MAS, CDH, PPHN)
PediatrickeECMO
(respiracni)
Kardiologicke
“ECMO”
(kardiochirurgicke
myokarditidy
kardiomyopatie
arytmie…)

3. pediatricke ECMO - pro koho, kdy a jak respiracni (MAS, CDH, PPHN)
Novorozenecke
ECMO
respiracni (MAS, CDH, PPHN)
PediatrickeECMO
(respiracni)

4. pediatricke ECMO - pro koho, kdy a jak
(respiracni)

5. pediatricke ECMO - pro koho, kdy a jak
(respiracni)

6. / year (decreasing)
/ year

7. pediatricke ECMO - pro koho a kdy
Indications:
• severe AHRF refractory to conventional treatment (???) (?how severe is severe enough? - patient likely to die)
reversible cause of respiratory failure.
less than (7) 10 (14) days invasive ventilation (???)
???
inclusion
exclusion
criteria for
pediatric
ECMO
???
inclusion
exclusion
criteria for
pediatric
ECMO
BMC Health Serv Res. 2006

8. pediatricke ECMO - pro koho a kdy
Exclusion criteria
• irreversible lung pathology such as fibrosis, pulmonary hypertension,… (???)
• contraindication to heparinisation (low patelets !!!)
• evidence of severe neurological injury
• established multi-organ dysfunction of 4 or more organs
???
not so easy
to evaluate
on admisssion
!!!

9. pediatricke ECMO - pro koho a kdy
Exclusion criteria – cont.
• ??? approach to co-morbidity (pre-existing co-morbid condition is acceptable if treatable and compatible with good quality of life)
• prolonged cardiac arrest (? how long is too long? 20 to 40 mins?)
ECMO as
“ECPR”
…ECMO rescued 1/3 of patients in whom death was otherwise certain…

10. pediatricke ECMO - pro koho a kdyas
“ECPR”
ECMO as
“ECPR”
pediatricke ECMO - pro koho a kdy

11. pediatricke ECMO - jak
overal survival
in pediatric ECMO
is 50-60%

12. pediatricke ECMO - pro koho, kdy a jak
United Kingdom
population 60 million
4 ECMO centers
total ECMO
around 200 runs/ year
Great Ormond Street Hospital Cardio-thoracic and ECMO unit
• admission per year
• around ECMO runs per year

13. pediatricke ECMO - pro koho, kdy a jak
Retrospective review of all paediatric ECMO cases ( age 28 days to 18 years) at Great Ormond Street Hospital for Children between 1992 – 2005 (primary cardiac patients excluded)
• total 124 paediatric respiratory ECMO cases were supported (range 7-15 cases per year)
• median age was 10.1 months and a median weight of 8kg
• median number of pre-ECMO ventilation days was 2
• median worst pre-ECMO OI was 39.1
• median duration of ECMO support was 9 days
2008 Brown et al.: GOSH ECMO data

14. pediatricke ECMO - pro koho, kdy a jak
overall year survival 59%
viral infections patients, survival 66%
pertussis 9 patients,
survival 55%
bacterial pneumonia 14 patients, survival 52%
sepsis/ septic shock 17 patients,survival 53%
aspiration 3 patients,all survived
hemo-oncol 2(+1) patients, all died
1 year survival in %
2008 Brown et al.: GOSH ECMO data

15. 2008 Brown et al.: GOSH ECMO data
pediatricke ECMO - jak
VA 63% of patients (46% mortality), VV 27% (24% mortality) conversion VV to VA 10% (50% mortality).
GOSH VV versus VA
ELSO registry data
2008 Brown et al.: GOSH ECMO data

16. pediatricke ECMO - jak

17. pediatricke ECMO - pro koho, kdy a jak
RISK FACTORS for DEATH
1.septic shock (P=0.01)
2.oxygenation index (P=0.05)
3.pre-ECMO ventilation (P=0.08)
4.end-organ dysfunction (P=0.09)
For each 5 points increment in OI the risk of death increased by 9%
Pre-ECMO OI
2008 Brown et al.: GOSH ECMO data

18. 53% children had pre-existing co-morbidity
pediatricke ECMO - pro koho, kdy a jak
…pre-existing co-morbidities may predispose children to develop severe AHRF but do not reduce survival
53% children had pre-existing co-morbidity
2008 Brown et al.: GOSH ECMO data

19. pediatricke ECMO - pro koho, kdy a jak
CONCLUSIONS:
… ECMO should be considered promptly in the deteriorating child who does not respond to conventional treatment…
2008 Brown et al.: GOSH ECMO data

20. total ECMO cost around £10 000 per day
pediatricke ECMO - pro koho, kdy a jak
CONCLUSIONS:
… ECMO should be considered promptly in the deteriorating child who does not respond to conventional treatment…
total ECMO cost around £ per day
2008 Brown et al.: GOSH ECMO data

22. pediatricke ECMO - pro koho, kdy a jak
long term follow up:
CONCLUSIONS: ECLS is a complex therapy which has been used in Australian children for 18 years; a third of children survived long term, and 96% of these had a favourable outcome

23. pediatricke ECMO - pro koho, kdy a jak
long term follow up:
total ECMO cost around £ per day
CONCLUSIONS: ECLS is a complex therapy which has been used in Australian children for 18 years; a third of children survived long term, and 96% of these had a favourable outcome