The Evaluation of Extracorporeal Membrane Oxygenation in Children with Acute Hypoxemic Respiratory Failure in China: A Five-year Single-center Retrospective Study

Abstract Objective: To summarize the clinical features, laboratory parameters, and outcomes of children with acute hypoxemic respiratory failure supported by extracorporeal membrane oxygenation and explore the risk factors of the prognosis.Methods: It’s a retrospective study from one hospital the Pediatric Intensive Care Unit of Children’s Hospital of Fudan University in China. Patients, aged 28 days to 18 years, with acute hypoxemic respiratory failure supported by mechanical ventilation underwent extracorporeal membrane oxygenation from January 2015 to December 2019 were enrolled in this study. The primary outcome was defined as in-hospital mortality within 28 d after admission. Demographics, medical history, comorbidities, laboratory findings, vital signs, medications, need for continuous renal replacement therapy, need for other rescue therapy, need for transportation, ventilator settings, oxygenation indices were recoded. Appropriate data entry and statistical analysis were performed on access 2007 and SPSS software version 23.Results: Fifty patients with severe acute hypoxemic respiratory failure were enrolled in the study. We analyzed 45 patients (90%) after excluding 5 for missing data. Overall mortality was 53.5%. The PaO2 prior to extracorporeal membrane oxygenation was higher (64 cmH2O [51.9, 70.0 cmH2O] vs 55.1 cmH2O [43.8,60.1], p = 0.009) and OI prior to extracorporeal membrane oxygenation was lower (33.3 [30.1, 40.7] vs 41.2 [33.2 -55.1], p = 0.031) in survivors than nonsurvivors. In multivariate analysis, PaO2 prior to extracorporeal membrane oxygenation was significantly associated with survival (odds ratio 1.129, 95% Cl 1.022 -1.247).Conclusions: Extracorporeal membrane oxygenation might be an alternative strategy for pediatric patients with severe acute hypoxemic respiratory failure Low PaO2 prior to extracorporeal membrane oxygenation indicated a poor prognosis. Maybe we should consider that extracorporeal membrane oxygenation should be implemented earlier.Trial registration: This study was registered on the Clinical Trail. The number is NCT04709432.