Tracheostomy and long-term mechanical ventilation in children after veno-venous extracorporeal membrane oxygenation.

Journal Article (Journal Article;Multicenter Study)

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.

Full Text

Duke Authors

Cited Authors

  • Mallory, PP; Barbaro, RP; Bembea, MM; Bridges, BC; Chima, RS; Kilbaugh, TJ; Potera, RM; Rosner, EA; Sandhu, HS; Slaven, JE; Tarquinio, KM; Cheifetz, IM; Friedman, ML

Published Date

  • September 2021

Published In

Volume / Issue

  • 56 / 9

Start / End Page

  • 3005 - 3012

PubMed ID

  • 34156159

Electronic International Standard Serial Number (EISSN)

  • 1099-0496

Digital Object Identifier (DOI)

  • 10.1002/ppul.25546

Language

  • eng

Conference Location

  • United States