The impact of mechanical ventilation time before initiation of extracorporeal life support on survival in pediatric XXXX : a review of the Extracorporeal Life Support Registry.

@entity1 @entity1576 @entity1167
OBJECTIVE: To evaluate the relationship between duration of mechanical ventilation before the initiation of extracorporeal life support and the survival rate in @entity1 with @entity1576 . Extracorporeal life support has been used as a rescue therapy for >30 yrs in @entity1 with severe @entity1576 . Previous studies suggest @entity1 who received >7-10 days of mechanical ventilation were not acceptable extracorporeal life support candidates as a result of irreversible lung damage. DESIGN: A retrospective review encompassing the past 10 yrs of the International Extracorporeal Life Support Organization Registry (January 1, 1999, to December 31, 2008). SETTING: Extracorporeal Life Support Organization Registry database. @entity1 : A total of 1325 @entity1 (>=  30 days and  <= 18 yrs) met inclusion criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The following pre-extracorporeal life support variables were identified as independently and significantly related to the chance of survival: 1) >14 days of ventilation vs. 0-7 days was adverse (odds ratio, 0.32; p < .001); 2) the presence of a @entity1167 was adverse (odds ratio, 0.56; p = .001); 3) pH per 0.1-unit increase was protective (odds ratio, 1.15; p < .001); 4) oxygenation index, per 10-unit increase was adverse (odds ratio, 0.95; p = .002); and 5) any diagnosis other than sepsis was related to a more favorable outcome. @entity1 requiring >7-10 or >10-14 days of pre-extracorporeal life support ventilation did not have a statistically significant decrease in survival as compared with @entity1 who received 0-7 days. CONCLUSIONS: There was a clear relationship between the number of mechanical ventilation days before the initiation of extracorporeal life support and survival. However; there was no statistically significant decrease in survival until >14 days of pre-extracorporeal life support ventilation was reached regardless of underlying diagnosis. We found no evidence to suggest that prolonged mechanical ventilation should be considered as a contraindication to extracorporeal life support in @entity1 with @entity1576 before 14 days.
