(370009-45) Extubation During Pediatric Extracorporeal Membrane Oxygenation Is Safe and Improves Mobility

Tuesday, January 23, 2024

10:40 AM – 10:50 AM MT

Location: Connections Central - Star Research Theater

Star Research Presenters(s)

Christina R. Rufener, MD, (she/her/hers)

n/a
San Diego, California

Co-Author(s)

ZB

Zaineb Boulil, MS

Research Statistician
Rady Children’s Hospital, United States
DS

Denise Suttner, MD

Clinical Director, NICU
University of California - San Diego, Rady Children’s Hospital, United States
DW

David K. Werho, MD

Associate Clinical Professor, Pediatrics
University of California - San Diego, Rady Children's Hospital, United States
HH

Helen Harvey, MD, MS

UC San Diego PICU Fellowship Program Director
University of California - San Diego, Rady Children’s Hospital, United States
NO

Nicole O'Brien, MD

Associate Professor of Clinical Medicine
Nationwide Children's Hospital, United States
Sapna Kudchadkar, MD, PhD, FCCM

Anesthesiology and Critical Care
Johns Hopkins University School of Medicine
Baltimore, MD
NC

Nicole G. Coufal, MD, PhD

Associate Professor
University of California - San Diego, Rady Children's Hospital, United States

Disclosure(s):

Christina R. Rufener: No relevant financial relationship(s) to disclose.

Sapna Kudchadkar, MD, PhD, FCCM: No relevant financial relationship(s) to disclose.

Introduction: ECMO is a critical rescue therapy for patients with refractory cardiopulmonary failure. Historically, ECMO patients have remained intubated and sedated. To minimize complications of prolonged mechanical ventilation, adults are increasingly extubated on ECMO to improve mobility and facilitate rehabilitation. This approach is not well described in pediatrics. We hypothesize that extubating pediatric ECMO patients is safe without increased incidence of complications.

Methods: This multi-center retrospective cohort study included ECMO centers contributing to the Extracorporeal Life Support Organization (ELSO) registry between 2018 and 2022. Patient were 30 days to 18 years old with a primary ECMO indication of respiratory failure and primary cardiac diagnoses were excluded. Patients were grouped as extubated or non-extubated on ECMO. P-PREP scores were calculated to compare predicted in-hospital mortality between groups. A multivariate logistic regression model was developed to identify factors independently associated with ECMO in-hospital mortality.

Results: Of 2416 patients meeting inclusion criteria, 112 were extubated (4.6%). There was no significant difference in P-PREP scores between groups. Extubated patients were older (median 6.1 vs. 2.4 years, p = 0.005), weighed more (median 32.5 vs. 13.3 kg, p < 0.001), more often cannulated to VV versus VA ECMO (p = 0.0005), and had a longer duration of ECMO support (median 275 vs. 167 hours, p < 0.0001). Extubated patients were better mobilized, defined as sitting in a bed or greater (29.5% vs. 4.8%, p < 0.0001). There was no significant increase in complications for extubated patients and no patients required re-intubation prior to decannulation. In-hospital mortality was higher in the extubated group (69.8% vs. 57.1% p = 0.0003) however in multivariate analysis, extubation was not a significant independent risk factor (p = 0.23). Independent predictors of mortality were weight (p = 0.006) and ECMO duration (p < 0.0001) whereas mobilization was protective (OR 0.34, p < 0.0001).

Conclusions: Extubating pediatric patients on ECMO remains an uncommon practice, and is seen primarily in older patients requiring a longer duration of ECMO support. Potential benefits of this strategy are improved mobility without an increase in ECMO-related complications.