Prognostic factors of extracorporeal membrane oxygenation as a rescue therapy for refractory septic shock in children

Background: The prognostic factors of extracorporeal membrane oxygenation (ECMO) as a kind of rescue therapy for children with refractory septic shock (RSS) and the optimal timing for ECMO intervention are critical for clinical work, but they are currently unclear. The study aims to explore the risk factors of prognosis of children with RSS on ECMO support and the optimal timing of ECMO intervention. Methods: Demographic data, disease-related information, treatment status, pre-ECMO hemodynamic parameters, and prognosis of enrolled children receiving ECMO support who were admitted consecutively to eight major pediatric ECMO centers in Chinese mainland from 2018–2020 were collected for analysis. Results: A total of 41 children with RSS were enrolled in the study, with a median age of 35.5 [interquartile range (IQR), 2, 169] months, of whom 25 (61.0%) were male. The overall survival discharge rate was 51.2%. For the survivors, the lactate value was 5.2 mmol/L and increased by 20% at the point of 6 hours after the diagnosis of RSS, while for the non-survivors, it was 11.2 mmol/L and increased by 60% (P=0.02 and 0.002). Those children who received ECMO support sooner had a higher survival rate (P=0.03). The median interval time from diagnosis of RSS to ECMO initiation was 6 (IQR, 5.0, 12.0) hours in the survival group and 13.8 (IQR, 9.5, 19.0) hours in the non-survival group (P=0.03). The mortality rate increased by 7.17 times when the interval exceeded 13.8 hours and by 10.96 times when the interval exceeded 20 hours. The multivariate analysis revealed that the 6-hour lactate value and the time interval between the diagnosis of RSS and ECMO initiation were significant predictors of prognosis in children with RSS. Conclusions: High 6-hour lactate value in children with RSS strongly predicts high mortality. The survival discharge rate of children with RSS may be improved when ECMO is initiated within 13.8 hours from RSS diagnosis.