• Erika Y Pineda, Mohammad Sallam, Ryan K Breuer, Geovanny F Perez, Brian Wrotniak, and Anil Kumar Swayampakula.
• Department of Pediatrics, Division of Critical Care Medicine, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, NY.
• Pediatr Crit Care Me. 2023 Aug 1; 24 (8): e397e402e397-e402.

ObjectivesExtracorporeal membrane oxygenation (ECMO) and/or inhaled anesthetics (IAs) are considered in the management of asthma when refractory to conventional therapy. We aimed to compare the outcomes of these two modalities in asthma PICU care and determine associated survival to hospital discharge among patients in a United States database.DesignRetrospective analysis using the Virtual Pediatric Systems (VPS, LLC) database.SettingPICUs participating in the VPS database.PatientsPatients less than 18 years old with diagnosis of asthma treated with IA and/or ECMO from January 2010 to December 2020.InterventionsNone.Measurements And Main ResultsA total of 221 patients were included; 149 (67%) received ECMO, 62 (28%) received IA, and 10 (5%) received both interventions. We failed to identify any difference between the ECMO and IA groups in demographics, Pediatric Index of Mortality 2 percentage, Pediatric Risk of Mortality 3 score, Pediatric Logistic Organ Dysfunction score, or pre-intervention pH and Pa co2 levels. Use of ECMO versus IA was associated with lower pre-intervention Pa o2 (60 torr [7.99 kPa] vs 78 torr [10.39 kPa]; p < 0.001) and higher utilization of high-frequency oscillatory ventilation. We failed to identify an association between type of intervention (IA vs ECMO) and greater odds of survival (57/62 [92%] vs 128/149 [86%]; odds ratio [OR], 1.87; 95% CI, 0.67-5.21; p = 0.23). However, these data do not exclude the possibility that IA use is associated with more than five-fold greater odds of survival. ECMO use was associated with longer duration of intervention (5 vs 1.3 d; p < 0.001) and PICU length of stay (LOS) (13 vs 7 d; p < 0.001). As expected, ECMO versus IA was also associated with greater odds of undergoing bronchoscopy (34% vs 11%; OR, 3.7; 95% CI, 1.5-9.4; p = 0.004).ConclusionsIn the VPS database of asthma management cases, we failed to identify an association between ECMO versus IA use and survival to hospital discharge. However, ECMO was associated with longer duration of intervention and PICU LOS.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

23 keywords...

hide…