Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 16:9:722477.
doi: 10.3389/fped.2021.722477. eCollection 2021.

Association of Fluid Balance and Survival of Pediatric Patients Treated With Extracorporeal Membrane Oxygenation

Prakadeshwari Rajapreyar  1   2 , Lauren Castaneda  3 , Nathan E Thompson  1   2 , Tara L Petersen  1   2 , Sheila J Hanson  1   2
Affiliations

Association of Fluid Balance and Survival of Pediatric Patients Treated With Extracorporeal Membrane Oxygenation

Prakadeshwari Rajapreyar et al. Front Pediatr. .

Abstract

The effect of positive fluid balance (FB) on extracorporeal membrane oxygenation (ECMO) outcomes in pediatric patients remains unknown. We sought to evaluate if positive FB in pediatric intensive care unit (PICU) patients with respiratory and/or cardiac failure necessitating ECMO was associated with increased morbidity or mortality. This was a multicenter retrospective cohort study of data from the deidentified PEDiatric ECMO Outcomes Registry (PEDECOR). Patients entered into the database from 2014 to 2017, who received ECMO support, were included. A total of 168 subjects met the study criteria. Univariate analysis showed no significant difference in total FB on ECMO days 1-5 between survivors and non-survivors [median 90 ml/kg (IQR 18-208.5) for survivors vs. median 139.7 ml/kg (IQR 11.2-300.6) for non-survivors, p = 0.334]. There was also no difference in total FB on ECMO days 1-5 in patients with no change in functional outcome as reflected by the Pediatric Outcome Performance Category (POPC) score vs. those who had worsening in POPC score ≥2 at hospital discharge [median 98 ml/kg (IQR 18-267) vs. median 130 ml/kg (IQR 13-252), p = 0.91]. Subjects that required 50 ml/kg or more of blood products over the initial 5 days of ECMO support had an increased rate of mortality with an odds ratio of 5.8 (95% confidence interval of 2.7-12.3; p = 0.048). Our study showed no association of the noted FB with survival after ECMO cannulation. This FB trend was also not associated with POPC at hospital discharge, MV duration, or ECMO duration. The amount of blood product administered was found to be a significant predictor of mortality.

Keywords: extracorporeal membrane oxygenation; fluid balance; fluid overload on ECMO; mechanical circulatory support; survival on ECMO.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Screened patients and outcomes.
Figure 2
Figure 2
Fluid balance (adjusted for patient weight) in survivors vs. non-survivors over the first 5 days of ECMO.
See this image and copyright information in PMC

References

    1. Schmidt M, Bailey M, Joshua K, Hodgson C, Cooper DJ, Scheinkestel C, et al. Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation. Intensive Care Med. (2014) 40:1256–66. 10.1007/s00134-014-3360-2 - DOI - PMC - PubMed
    1. Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. (2011) 365:1905–14. 10.1056/NEJMct1103720 - DOI - PubMed
    1. Sayer GT, Baker JN, Parks KA. Heart rescue: the role of mechanical circulatory support in the management if severe refractory cardiogenic shock. Curr Opin Crit Care. (2012) 18:409–16. 10.1097/MCC.0b013e328357f1e6 - DOI - PubMed
    1. Jenks CL, Raman L, Dalton HJ. Pediatric extracorporeal membrane oxygenation. Crit Care Clin. (2017) 33:825–41. 10.1016/j.ccc.2017.06.005 - DOI - PubMed
    1. Combes A, Brechot N, Luyt CE, Schmidt M. What is the niche for extracorporeal membrane oxygenation in severe acute respiratory distress syndrome? Curr Opin Crit Care. (2012) 18:527–32. 10.1097/MCC.0b013e328357f090 - DOI - PubMed