Extracorporeal life support (ECLS) for pewatric trauma patients with respiratory failure the extracorporeal life support organization (ELSO) registry

Introduction: Reports describing the application of ECLS in the management of patients with post-traumatic respiratory failure remain limited to small case series. We nave reviewed a large ECLS database to better evaluate the role of ECLS in the management of pédiatrie trauma patients with respiratory failure unresponsive to conventional support. Methods: Registry records were retrospectively reviewed for al pediatre patients (age<16) supported by ECLS for respiratory failure following trauma. Statistical significance was determined using Students West (p<0.05). Results: Over a 10-year period (1987-1986). 89 injured children (mean age 3.9+3.6 yrs, range 0.25-16 yrs) were placed on ECLS for respiratory failure, unresponsive to conventional management Mechanisms of injury were; bum 22 (25%). inhalation 13 (14%), blunt trauma 26 (29%). near drowning 22 (25%), other 6 (7%). Pulmonary contusions were reported in 16 (62%) of the 26 chidren with blunt trauma. Overal survival occurred in 57 (64%) children [bum 16 (73%). inhalation 9 (69%). blunt trauma 10 (38%). near drowning 17 (77%), other 5 (83%)]. UrAe previous reports, the duration of pre-ECLS intubation did not affect survival (6.6±5.5 vs. 5.2±4.1 days, alive vs. dead, p>0.05). The duration on ECLS was also similar ter each outcome (9.9±6.2 vs. 11.9±7.1 days, alive vs. dead, p>0.05). Fifty hemorrhagicoornpicalionswerereporMin42(47%)diidran. Surgical site bleeding was the most common occurring in 27 (30%). Gastrointestinal hemorrhage was reported in only 2 (2%). Intracrantal hemorrhage occurred in 5 (6%) children, but in only 1 (4%) with blunt injury. Forty (45%) children were ultimately discharged to home. Conclusions: We conclude that despite an increased hemorrhage morbidity, ECLS is a reasonable option for support of pediatrie trauma patients with respiratory failure, who fail conventional management.