ECMO for Refractory Paediatric Septic Shock - Outcomes from a medium to high volume centre

Abstract

Background: Despite the early concerns regarding its utility in sepsis, use of ECMO has evolved and demonstrated survival benefit in this cohort of critically unwell children. Methods: We studied the cohort of children <18 years of age with refractory septic shock supported with ECMO at the Queensland Children's Hospital from 2011-2024. A retrospective review of the ECMO database was performed. Descriptive analysis of the data is presented. Results: A total of 229 patients received 251 runs of ECMO during the study period, of which 41 patients were placed on ECMO for refractory septic shock. The median age was 1.9 (IQR 0.8- 9.2) years. The median weight was 12 (IQR 9.2-25.2) Kg. The median time of ICU management prior to ECMO cannulation was 10 (IQR 3-89) hours. All patients were placed on VA ECMO initially and five patients needed conversion to VV ECMO. The median duration of ECMO was 5.8 (IQR 3.1-8.6) hours. 25/41 (61%) were cannulated centrally and the rest peripherally. The median flow at 4 h was 2.9 (IQR 2.4-3.2) L/min/m2 and the flow at 24 hours was 2.7 (IQR 2.6-3.2) L/min/m2. The pH pre-ECMO was 7.13 (IQR 7.03-7.23) and was 7.38 (IQR 7.3-7.4) at 24 hours. The Lactate at 4 and 24 hours was 7.3 (IQR 0.3-12.5) mmol/L and 4.6 (IQR 2.7-7.3) mmol/L respectively. A total of 85 ELSO defined complications were noted in the 41 ECMO runs. Survival to hospital discharge for the cohort was 59% (24/41). Of the patients who had a cardiac arrest prior to ECMO, 43% survived (6/14). The median PICU length of stay was 19.1 (IQR 4.2-33.8) days and the hospital length of stay was 29.2 (IQR 7.7-55.1) days. Conclusions: ECMO offers survival benefit in children with refractory septic shock supported on ECMO in a medium to high volume centre.