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

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)

Note

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funder did not participate in the work.

MEETING PRESENTATION: Poster presentation in 2020 at the ELSO Annual Conference, USA and in 2021 at the SCCM Annual Conference, USA

Publication History

Received: 18 July 2022

Accepted: 28 September 2022

Article published online:
03 January 2023

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