Extracorporeal life support in pediatric burn care: A systematic review

Abstract

A systematic review of the role of extracorporeal life support (ECLS) in pediatric patients with burn and smoke inhalation injury was undertaken. A systematic search of the literature according to a specific combination of keywords to ascertain the effectiveness of this treatment strategy was conducted. A total of 14 articles out of 266 were considered suitable for the analysis in pediatric patients. The PICOS approach and PRISMA flow chart were followed for the purpose of this review. Despite the limited number of studies on the subject, ECMO in burn and smoke inhalation injury provides an additional level of support in pediatric patients leading to positive outcomes. V-V ECMO demonstrated the best overall survival of all configurations, with similar outcomes to non-burned patients. Prolonged mechanical ventilation prior to ECMO decreases survival and increases mortality by 12% with each additional day off ECMO. Good outcomes have been described for scald burns, dressing changes, and pre-ECMO cardiac arrest.

Keywords

Burn injury ECLS ECMO extracorporeal membrane oxygenation inhalation injury pediatric

Get full access to this article

View all access options for this article.

References

Saeman

Hodgman

Burris

, et al. Epidemiology and outcomes of pediatric burns over 35 years at Parkland Hospital. Burns 2016; 42: 202–208.

Jeschke

Herndon

. Burns in children: standard and new treatments. Lancet 2014; 383: 1168–1178.

Szentgyorgyi

Shepherd

Dunn

, et al. Extracorporeal membrane oxygenation in severe respiratory failure resulting from burns and smoke inhalation injury. Burns 2018; 44: 1091–1099.

Thiagarajan

Barbaro

Rycus

, et al. Extracorporeal life support organization registry international report 2016. ASAIO J 2017; 63: 60–67.

Brown

Traber

Herndon

, et al. The use of venovenous extracorporeal membrane oxygenation in sheep receiving severe smoke inhalation injury. Burns Incl Therm Inj 1987; 13: 34–38.

UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. UK Collaborative ECMO Trail Group. Lancet 1996; 348: 75–82.

Ombrellaro

Goldthorn

Harnar

, et al. Extracorporeal life support for the treatment of adult respiratory distress syndrome after burn injury. Surgery 1994; 115: 523–526.

Heggers

Muller

Elwood

, et al. Ascariasis pneumonitis: a potentially fatal complication in smoke inhalation injury. Burns 1995; 21: 149–151.

Goretsky

Greenhalgh

Warden

, et al. The use of extracorporeal life support in pediatric burn patients with respiratory failure. J Pediatr Surg 1995; 30: 620–623.

10.

Lessin

el-Eid

Klein

, et al. Extracorporeal membrane oxygenation in pediatric respiratory failure secondary to smoke inhalation injury. J Pediatr Surg 1996; 31: 1285–1287.

11.

O’Toole

Peek

Jaffe

, et al. Extracorporeal membrane oxygenation in the treatment of inhalation injuries. Burns 1998; 24: 562–565.

12.

Cedidi

Hierner

Pichlmaier

, et al. Survival of severe ARDS with five-organ system failure following burns and inhalation injury in a 15-year-old patient. Burns 2003; 29: 389–394.

13.

Pierre

Zwischenberger

Angel

, et al. Extracorporeal membrane oxygenation in the treatment of respiratory failure in pediatric patients with burns. J Burn Care Rehabil 1998; 19: 131–134.

14.

Hilt

Graves

Chernin

, et al. Successful use of extracorporeal membrane oxygenation to treat severe respiratory failure in a pediatric patient with a scald injury. Crit Care Nurse 1998; 18: 63–72.

15.

Kane

Greenhalgh

Warden

, et al. Pediatric burn patients with respiratory failure: predictors of outcome with the use of extracorporeal life support. J Burn Care Rehabil 1999; 20: 145–150.

16.

Askegard-Giesmann

Besner

Fabia

, et al. Extracorporeal membrane oxygenation as a lifesaving modality in the treatment of pediatric patients with burns and respiratory failure. J Pediatr Surg 2010; 45: 1330–1335.

17.

Asmussen

Maybauer

Fraser

, et al. Extracorporeal membrane oxygenation in burn and smoke inhalation injury. Burns 2013; 39: 429–435.

18.

Eldredge

Zhai

Cochran

. Effectiveness of ECMO for burn-related acute respiratory distress syndrome. Burns 2019; 45: 317–321.

19.

Thompson

Dawoud

Castle

, et al. Extracorporeal membrane oxygenation support for pediatric burn patients: Is it worth the risk? Pediatr Crit Care Med 2020; 21: 469–476.

20.

Suzuki

Williams

Patino

, et al. Extracorporeal membrane oxygenation for pediatric burn patients: is management improving over time? ASAIO J 2022; 68: 426–431.

21.

Patterson

Beyene

Gil

, et al. Extracorporeal membrane oxygenation in pediatric burn patients without inhalation injury: a unique population? J Burn Care Res. Epub ahead of print 5 July 2022. DOI: 10.1093/jbcr/irac093.