Viral pneumonia accounts for approximately 30% of all pediatric respiratory failure cases that require extracorporeal membrane oxygenation (ECMO), with reported survival rates near 60%. For adenovirus, the most common viral etiology in this category following RSV, survival has previously been reported to be much lower, with more than two-thirds of patients dying despite ECMO. We recently had a case at our institution of an 11-month-old Native American female with adenovirus pneumonia who survived following 36 days on ECMO.
Purpose We sought to query the Extracorporeal Life Support Organization (ELSO) registry to characterize survival in patients with viral pneumonia treated with prolonged ECMO.
Methods Data prospectively collected and submitted to the ELSO Registry (Ann Arbor, MI) from 1988 through October of 2005 were reviewed. Those patients between the ages of 1 month and 10 years with diagnostic codes consistent with viral pneumonia defined the study population. Demographic data collected on each patient included specific viral organisms, sex, age, weight, pre-ECMO course, duration of ECMO, complications, and survival. Prolonged ECMO support was defined as being greater than 14 days.
Results 498 patients met study criteria and had an overall survival rate of 60%. RSV was the most common diagnosis, representing 75% of the total with 64% survival. This was followed by adenovirus representing 12%, influenza 8%, and parainfluenza 5% of the study population with 52%, 46%, and 44% survival, respectively. The average time on ECMO for all survivors was 12.2 vs 12.9 days for nonsurvivors. Overall, 36% of patients with viral pneumonia were still on ECMO after 14 d, 15% after 21 d, and < 2% after 28 d. Prolonged ECMO support was associated with increased mortality over time, with survival decreasing to 55%, 45%, and 33%, respectively. Of interest, 5/14 patients with RSV survived past 28 days vs 0/5 with adenovirus.
Conclusion Our case represents the first reported child with adenovirus surviving after more than 4 weeks on ECMO. While the majority of pediatric patients with viral pneumonia are off ECMO by 2 to 3 weeks, a small percentage may require support beyond 28 days and still have a reasonable chance of survival.
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