TORONTO -- Kids suffering a near fatal asthma exacerbation can, for the most part, be safely treated with extracorporeal membrane oxygenation (ECMO), researchers said here.
In a retrospective analysis of the Extracorporeal Life Support Organization (ELSO) database covering nearly 3 decades, about four out of every five such patients had both full lung recovery and survival, according to Rebecca Kohlberg-Davis, MD, of Connecticut Children's Medical Center in Hartford, and colleagues.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
But complications were common and one in five patients had three adverse events or more -- a level that was associated with significantly lower odds of lung recovery, Kohlberg-Davis reported at CHEST, the annual meeting of the American College of Chest Physicians annual meeting.
Moreover, the venovenous (VV) approach was associated with better odds of lung recovery and survival than the venoarterial (VA) method, she reported.
The data would "suggest [ECMO] is safe given appropriate patient choice," commented CHEST session co-moderator Keith Wille, MD, of the University of Alabama at Birmingham.
The analysis shows there "seems to be a role for ECMO support," Wille told ľֱ. But he cautioned the data contains a restricted suite of variables and is based on voluntary reporting, factors that limit its value.
On the other hand, it's unlikely that better data will come along. "The [ELSO] database is probably as good as it's going to get," he said.
Severe asthma exacerbations commonly lead to admission to the pediatric ICU, where ECMO is increasingly being used in therapy, but there's not a lot of research on outcomes, Kohlberg-Davis said.
Her group turned to the information contained in the from 1988 through 2016 to pin down the factors involved with various outcomes.
All told, the database contains information on 371 children with asthma who were treated with ECMO, with a median age of 7.5 year. The median ECMO duration was 123 hours; about 65.3% had VV cannulation and 33.1% had VA cannulation. Some data is incomplete, Kohlberg-Davis noted.
Some 302 patients had hypercarbic respiratory failure, 117 had hypoxic respiratory failure, and 90 had mixed respiratory failure. Children with hypercarbic respiratory failure were more likely to receive VV cannulation, while VA cannulation was more likely among those with hypoxemic or combined respiratory failure.
The bottom line was that 83% of the children had lung recovery and 77% survived until discharge, Kohlberg-Davis said.
The investigators also found that children with hypoxemic respiratory failure had a significantly lower likelihood of lung recovery, with an odds ratio of 4.9.
Some 80% of the runs were associated with one or more complications, and 20% of patients had three or more complications. Having three or more complications was associated with a lower chance lung recovery (OR 0.29).
Also, 22% of children who had VA cannulation had a neurologic complication, compared with 5%, of those getting VV cannulation (OR 4.8).
In addition, 90% of those who had VV cannulation had lung recovery, compared with 69% of those who had VA cannulation, a difference that was highly significant.
Among children whose lungs recovered, VV cannulation had a 3.6-fold higher likelihood of survival than those who had VA cannulation.
The findings show that ECMO is usually life saving but doctors need to be prepared to manage the risks, Kohlberg-Davis stated.
Disclosures
Kohlberg-Davis and co-authors, as well as Wille, disclosed no relevant relationships with industry.
Primary Source
CHEST
Kohlberg-Davis R, et al "Lung recovery and survival after extracorporeal membrane oxygenation for near fatal pediatric asthma" CHEST 2017.