Role of Extracorporeal Membrane Oxygenation in pediatric sepsis: Systematic Review and metanalysis

Abstract

Background: We sought to review peer-reviewed publications on effectiveness of ECMO in children with sepsis. Methods: Studies reporting on mortality in children with sepsis needing ECMO published in several databases from 1972 till February 2020, were included in the review. This study was done in adherence to PRISMA, after registering the review protocol with PROSPERO. Publications were reviewed for quality using the GRADE system. Random-effects metaanalyses were conducted, and 95% confidence intervals were computed using the Clopper-Pearson method. Outliers were identified statistically and removed if there was considerable heterogeneity. The primary outcome measure was survival to discharge. Secondary outcome measures included hospital stay, subgroup analysis of neonatal and pediatric groups, types and duration of ECMO and complications. Results: Of the 2054 articles screened, we identified 22 original articles for systematic review and meta-analysis. Cumulative pooled estimate of survival (13 studies, 2050 patients) in the cohort was 58% (95%CI: 49-66%). They had a median length of hospital stay of 28.8 days, median intensive care unit stay of 13.5 days, and median ECMO duration of 110 hours. Children needing venoarterial ECMO (9 studies, 209 patients) showed overall pooled survival of 63% (95%CI: 46-79%). Neonates with sepsis needing ECMO (7 studies, 85 neonates) had pooled survival of 73% (95%CI: 56-87%). Gram positive organisms accounted for majority (49%) of infection in septic children needing ECMO. Conclusion: Survival rates of children with sepsis needing ECMO was 58%. Neonates had higher survival rates (73%); gram positive organisms accounted for majority of infections in children needing ECMO.L6337189652020-12-25 <br />