Respiratory syncytial virus (RSV) infection is a major cause of hospitalization amongst infants. Some infants progress to severe respiratory failure and death despite maximal respiratory support. Extracorporeal membrane oxygenation (ECMO) has been used as a rescue therapy in such cases with 49- 58% survival.12 This study analyzes the outcomes in a small case series utilizing early application of ECMO.
Retrospective chart review of infants with RSV infection undergoing ECMO in last 2 years at a tertiary care children’s hospital was undertaken. Demographic data, respiratory indices, blood gas values, radiographic findings and length of ventilation were collected.
Six children were placed on ECMO; five were infants with ages ranging 28-61 days. Table 1TABLE 1Duration of illness (range(mean))4–15 (8)Ventilator days2–11 (6.5)Mean airway pressure (MAP)12–38 (24)Peak inspiratory pressure (PIP)32–45 (38)pH7.25–7.44(7.32)PaCO232–75(58)PaO252–88(66)Oxygenation index (OI)12–55(33.6)PAO2-PaO2 (A-a gradient)353–615(457)PaO2/PAO20.08–0.16(0.10)PaO2/Fio2 (P/F)60–100(68.6)shows the respiratory indices at the time of placement on ECMO. All had radiological evidence of severe lung injury including air leak syndromes in four (figure 1). The indications for ECMO (veno-venous in 3; veno-arterial in 3 due to small jugular veins) were persistent hypoxemia (n=5) and severe air leaks (n=1) despite maximal ventilatory support including high frequency ventilation (n=4). The median ECMO duration was 358 hours (range 211– 408). All were successfully decannulated , extubated and discharged from ICU. Complications included nonprogressive intracerebral bleed (n=1), cannula site bleeding(n=1) and fluid overload requiring hemofiltration (n=5).
All patients survived and had better than previously described survival rates of 49-58%.12 All of our patients had a predicted mortality of 77% or more based on their respiratory indices.3 The improved survival in our small series could be due to gentler ventilation (lower MAP, PIP) and early application of ECMO. Higher P/F ratios, Lower OI, MAP & PIP have been associated with survival in previous series suggesting early ECMO may improve survival.CLINICAL IMPLICATION: Early application of ECMO may lead to improved survival in severe respiratory failure secondary to RSV.
A. Haque, None.