Outcome of Severe Adenoviral Respiratory Infection Supported With Extracorporeal Membrane Oxygenation: A Multicenter PICU Study From Colombia (2018–2022)

OBJECTIVES: To compare survival, clinical characteristics, complications, and duration of extracorporeal membrane oxygenation (ECMO) support in pediatric patients with severe adenoviral respiratory infections vs. those with other viral respiratory infections. DESIGN: Multicenter, retrospective observational study. SETTING: Seven PICUs in Colombia, South America. PATIENTS: Children 1 month to 18 years old who received ECMO support between January 2018 and December 2022. The primary outcome was survival in children with severe adenoviral infection requiring ECMO, compared with those with ECMO due to other viral respiratory infections. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 205 patients were included; 39% (80/205) had adenoviral infections and 61% (125/205) had other viral respiratory infections. We failed to find an association between the adenovirus group, vs. the nonadenovirus group, and 28-day survival (62/80 [77.6%] vs. 92/125 [73.6%]; p = 0.513). Independent pre-ECMO factors associated with greater odds (adjusted odds ratio [aOR], 95% CI) of mortality across both groups included Vasoactive-Inotropic Score (VIS > 15; aOR, 3.18 [95% CI, 1.08-7.45]), arterial pH less than 7.2 (aOR, 3.79 [95% CI, 1.75-5.52]), and time from meeting ECMO criteria to actual cannulation greater than 13 hours (aOR, 4.04 [95% CI, 1.72-7.21]). Hemorrhagic complications occurred in 81 of 205 (40%) of all patients, and CNS hemorrhage and cannulation site bleeding were the most common locations of bleeding. Greater odds of hemorrhagic complication were associated with age younger than 36 months, previous severe acute respiratory syndrome coronavirus 2 infection, ECMO duration greater than 10 days, and use of continuous renal replacement therapy during ECMO. CONCLUSIONS: In pediatric patients with severe adenoviral infections requiring ECMO support, compared with those with other viral infections requiring ECMO, we failed to identify associated greater odds of mortality. Key factors associated with greater odds of mortality included pre-ECMO acidosis, high VIS, and greater than 13-hour delay in initiating ECMO support.