Extracorporeal Membrane Oxygenation and Hemolytic Uremic Syndrome in Children: Outcome Review of a Multicenter National Database

Mireille Liboiron; Matthew P. Malone; Clare C. Brown; Parthak Prodhan

doi:10.1055/s-0042-1758478

Journal of Pediatric Intensive Care, Inhaltsverzeichnis

J Pediatr Intensive Care
DOI: 10.1055/s-0042-1758478

Original Article

Extracorporeal Membrane Oxygenation and Hemolytic Uremic Syndrome in Children: Outcome Review of a Multicenter National Database

Authors

Mireille Liboiron

¹Division of Pediatric Critical Care Medicine, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Matthew P. Malone

¹Division of Pediatric Critical Care Medicine, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Clare C. Brown

²Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Parthak Prodhan

¹Division of Pediatric Critical Care Medicine, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States

Abstract

Hemolytic uremic syndrome (HUS) is a triad of hemolytic anemia, thrombocytopenia, and acute renal failure. In critically ill children with HUS, extrarenal manifestations may require intensive care unit admission and extracorporeal membrane oxygenation (ECMO) support. Outcomes specific to HUS and ECMO in children have not been well investigated. The primary aim of this project was to query a multicenter database to identify risk factors associated with mortality in HUS patients supported on ECMO. A secondary aim was to identify factors associated with ECMO utilization in children with HUS. Utilizing the Pediatric Health Information System database (January 2004 and September 2018), this retrospective, multicenter cohort study identified the index HUS hospitalization among children aged 0 to 18 years. Univariate analysis was used to compare demographics, clinical characteristics, and procedures to identify risk factors associated with adverse outcomes. Among 4,144 subjects, 37 were supported on ECMO. Survival for those on ECMO support was 54%. Among nonsurvivors, 59% of deaths occurred within 14 days of hospitalization. The mean hospital LOS was 15.9 days in nonsurvivors versus 53.9 days for survivors (p < 0.001). When comparing subjects supported on ECMO to those who were not, patients with ECMO support had statistically longer hospital LOS and higher rates of extrarenal involvement (p < 0.001). This study found a mortality rate of 46% among HUS patients requiring ECMO. The investigated clinical risk factors were not associated with mortality among the ECMO population. The study identifies risk factors associated with ECMO utilization in children with HUS.

Keywords

confidence interval (CI) - correct procedures terminology (CPT) - extracorporeal membrane oxygenation (ECMO) - hemolytic uremic syndrome (HUS) - International Classification of Diseases, Ninth Revision (ICD-9) - International Classification of Diseases, Tenth Revision (ICD-10) - length of stay (LOS) - odds ratio (OR) - Pediatric Health Information System (PHIS®) - Pediatric, Logistic Organ Dysfunction (PELOD) - thrombotic microangiopathy (TMA)

Volltext

Referenzen

References
1 Rigamonti D, Simonetti GD. Direct cardiac involvement in childhood hemolytic-uremic syndrome: case report and review of the literature. Eur J Pediatr 2016; 175 (12) 1927-1931
2 F Andersen R, V Bjerre J, V Povlsen J, Veien M, Kamperis K, Rittig S. HUS-induced cardiac and circulatory failure is reversible using cardiopulmonary bypass as rescue. Pediatr Nephrol 2017; 32 (11) 2155-2158
3 Thomas NJ, Messina JJ, DeBruin WJ, Carcillo JA. Cardiac failure in hemolytic uremic syndrome and rescue with extracorporeal life support. Pediatr Cardiol 2005; 26 (01) 104-106
4 Vaughn JL, Moore JM, Cataland SR. Acute systolic heart failure associated with complement-mediated hemolytic uremic syndrome. Case Rep Hematol 2015; 2015: 327980
5 Abu-Arafeh I, Gray E, Youngson G, Auchterlonie I, Russell G. Myocarditis and haemolytic uraemic syndrome. Arch Dis Child 1995; 72 (01) 46-47
6 Mohammed J, Filler G, Price A, Sharma AP. Cardiac tamponade in diarrhoea-positive haemolytic uraemic syndrome. Nephrol Dial Transplant 2009; 24 (02) 679-681
7 Kelham MD, Gleeson L, Alcalde I, Spiritoso R, Proudfoot AG, Scully M. Extra-corporeal membrane oxygenation and eculizumab: atypical treatments for typical haemolytic uraemic syndrome. J Intensive Care Soc 2020; 21 (02) 191-193
8 Pape L, Hartmann H, Bange FC, Suerbaum S, Bueltmann E, Ahlenstiel-Grunow T. Eculizumab in typical hemolytic uremic syndrome (hus) with neurological involvement. Medicine (Baltimore) 2015; 94 (24) e1000
9 Bridges BC, Hardison D, Pietsch J. A case series of the successful use of ECMO, continuous renal replacement therapy, and plasma exchange for thrombocytopenia-associated multiple organ failure. J Pediatr Surg 2013; 48 (05) 1114-1117
10 Mijatovic D, Blagaic A, Zupan Z. Case report: severe form of hemolytic-uremic syndrome with multiple organ failure in a child: a case report. F1000 Res 2014; 3: 79
11 Naour O, Drighil A, Idouz K. et al. Dilated cardiomyopathy: a rare and late complication of the hemolytic-uremic syndrome. J Cardiol Cases 2019; 20 (04) 125-128
12 Jenssen GR, Vold L, Hovland E, Bangstad HJ, Nygård K, Bjerre A. Clinical features, therapeutic interventions and long-term aspects of hemolytic-uremic syndrome in Norwegian children: a nationwide retrospective study from 1999-2008. BMC Infect Dis 2016; 16: 285
13 Huang DT, Chi H, Lee HC, Chiu NC, Huang FY. T-antigen activation for prediction of pneumococcus-induced hemolytic uremic syndrome and hemolytic anemia. Pediatr Infect Dis J 2006; 25 (07) 608-610
14 Yesilbas O, Yozgat CY, Akinci N. et al. Sudden cardiac arrest and malignant ventricular tachycardia in an 8-year-old pediatric patient who has hemolytic uremic syndrome associated with Shiga toxin-producing Escherichia coli . J Pediatr Intensive Care 2020; 9 (04) 290-294
15 Askiti V, Hendrickson K, Fish AJ, Braunlin E, Sinaiko AR. Troponin I levels in a hemolytic uremic syndrome patient with severe cardiac failure. Pediatr Nephrol 2004; 19 (03) 345-348

Zusatzmaterial

Supplementary Material (PDF)