Indications and Outcome of Pediatric Patients on Extracorporeal Membrane Oxygenation at Tertiary Care Centers across India

Background: Extracorporeal membrane oxygenation (ECMO) is the only treatment modality for refractory cardiopulmonary illness but is still underutilized in the pediatric population.This article gives an overview of common pediatric indications and outcomes at tertiary care centers across India.Methodology: This study is a retrospective, cross-sectional questionnaire-based observational study, across tertiary care centers performing pediatric ECMO.The survey encompassed questions about indications, care practices, supportive care, complications, outcomes and long-term sequelae of pediatric patients on ECMO.Results: A very limited number of institutes are conducting ECMO throughout India, out of them, very few have experience of pediatric ECMO.Only 9 centers participated in the survey.Response taken from these centers revealed indications of initiating ECMO in the neonatal population were equally distributed among cardiac causes, persistent pulmonary hypertension (PPHN), and meconium aspiration syndrome (MAS).Indications for initiating ECMO in the pediatric age-group are mainly for ARDS, followed by cardiac causes.The average duration of ECMO use in pediatric respiratory causes is 10-15 days, and for cardiac causes, is averaging around 3-5 days.Around 66% of institutes took around 3-5 days between the onset of severe ARDS, and initiation of ECMO.About 75% of centers preferred blood priming of the circuit over crystalloid priming.Infection and bleeding are the most common complications, followed by thromboembolic and renal injuries.Oxygen dependency and cognitive and neuropsychological impairments were the most common sequelae.Conclusion: Extracorporeal membrane oxygenation is being used across a broad category of indications in pediatric and neonatal patients, but there is a pressing need for the capacity building of major tertiary care centers for the use of ECMO with the view of the improving survival of those with maximum illness.Data collected from the central registry should be aptly used for improving patient selection, care and outcomes of patients initiated on ECMO.